TERRY ROBERT ROTH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036059503

License Status

NOT RENEWED

Business

First Name

TERRY ROBERT

Last Name

ROTH

Suffix

Business Name

TERRY ROBERT ROTH MD

Original Issue Date

01/22/1980

Effective Date

08/11/2017

Expiration Date

09/30/2020

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

01/14/2021