CHARLES L ROLLER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****00

License Status

NOT RENEWED

Business

First Name

CHARLES

Middle

Last Name

ROLLER

Suffix

Business Name

CHARLES L ROLLER MD

Original Issue Date

10/04/2006

Effective Date

07/15/2008

Expiration Date

07/31/2011

City

MARYVILLE

State

Zip

62062

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011