RALPH EDWIN DEFOREST MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****04

License Status

NOT RENEWED

Business

First Name

RALPH EDWIN

Last Name

DEFOREST

Suffix

Business Name

RALPH EDWIN DEFOREST MD

Original Issue Date

01/01/1997

Expiration Date

07/31/2005

City

WILMETTE

State

Zip

60091

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006