JONATHAN D ROOT MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****17

License Status

NOT RENEWED

Business

First Name

JONATHAN D

Last Name

ROOT

Suffix

Business Name

JONATHAN D ROOT MD

Original Issue Date

08/18/1993

Effective Date

08/18/1993

Expiration Date

07/31/2005

City

GRANITE CITY

State

Zip

62040

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006