DAVID ANTHONY RODEBERG MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****19

License Status

NOT RENEWED

Business

Title

First Name

DAVID

Middle

ANTHONY

Last Name

RODEBERG

Business Name

DAVID ANTHONY RODEBERG MD

Original Issue Date

01/09/2020

Effective Date

10/09/2020

Expiration Date

07/31/2023

City

SPRINGFIELD

State

Zip

62769

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023