NICHOLAS CONNOR ROTH MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125083173

License Status

ACTIVE

Business

Title

First Name

NICHOLAS

Middle

CONNOR

Last Name

ROTH

Business Name

NICHOLAS CONNOR ROTH MD

Original Issue Date

06/26/2024

Effective Date

06/26/2024

Expiration Date

06/25/2027

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

04/12/2024