ROBERT EDWARD STALLWORTH MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125009618

License Status

EXPIRED

Business

First Name

ROBERT EDWARD

Last Name

STALLWORTH

Suffix

Business Name

ROBERT EDWARD STALLWORTH MD

Original Issue Date

01/01/1998

Effective Date

01/01/1998

Expiration Date

09/15/1980

City

SPRINGFIELD

State

Zip

62781

County

SANGAMON

Specialty/Qualifier

Rhinology Fellowship

Ever Disciplined

LastModifiedDate

10/21/2010