EDMUNDO D SANDOVAL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****05

License Status

NOT RENEWED

Business

First Name

EDMUNDO

Middle

Last Name

SANDOVAL

Suffix

Business Name

EDMUNDO D SANDOVAL MD

Original Issue Date

05/10/1988

Effective Date

04/11/2017

Expiration Date

09/30/2020

City

MURPHYSBORO

State

Zip

62966

County

JACKSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021