ROBERT G MOULT 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

First Name

ROBERT G

Last Name

MOULT

Business Name

ROBERT G MOULT

Original Issue Date

10/25/1987

Effective Date

10/25/1987

Expiration Date

07/31/1990

City

CHICAGO

State

Zip

60615

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006