ANITA P WATERFORD DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036110044

License Status

NOT RENEWED

Business

First Name

ANITA

Middle

Last Name

WATERFORD

Suffix

Business Name

ANITA P WATERFORD DO

Original Issue Date

09/03/2003

Effective Date

09/03/2003

Expiration Date

07/31/2005

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

02/18/2009