RUTH DIANE MAYFORTH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036105117

License Status

NOT RENEWED

Business

First Name

RUTH

Middle

DIANE

Last Name

MAYFORTH

Suffix

Business Name

RUTH DIANE MAYFORTH MD

Original Issue Date

07/06/2001

Effective Date

07/12/2011

Expiration Date

07/31/2014

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Ever Disciplined

LastModifiedDate

11/17/2014