TED WILLIAM GRACE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****28

License Status

NOT RENEWED

Business

Title

First Name

TED

Middle

WILLIAM

Last Name

GRACE

Business Name

TED WILLIAM GRACE MD

Original Issue Date

11/15/2011

Effective Date

11/15/2011

Expiration Date

07/31/2014

City

CARBONDALE

State

Zip

62901

County

JACKSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020