JACK W ROSTAS III MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****10

License Status

NOT RENEWED

Business

Title

First Name

JACK

Middle

Last Name

ROSTAS

Suffix

III

Business Name

JACK W ROSTAS III MD

Original Issue Date

07/27/2017

Effective Date

07/27/2017

Expiration Date

09/30/2020

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021