ROME CHARLES WALTER DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125049938

License Status

CANCELLED

Business

First Name

ROME

Middle

CHARLES

Last Name

WALTER

Suffix

Business Name

ROME CHARLES WALTER DO

Original Issue Date

07/01/2005

Effective Date

07/01/2005

Expiration Date

06/30/2008

City

QUINCY

State

Zip

62301

County

ADAMS

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006