RAFAEL ROBERTO MEDINA 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

RAFAEL

Middle

ROBERTO

Last Name

MEDINA

Suffix

Business Name

RAFAEL ROBERTO MEDINA MD

Original Issue Date

03/02/2000

Effective Date

03/02/2000

Expiration Date

07/31/2002

City

HERRIN

State

Zip

62948

County

WILLIAMSON

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

10/09/2006