WALTER RAY ELLISTON MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****34

License Status

CANCELLED

Business

First Name

WALTER

Middle

RAY

Last Name

ELLISTON

Suffix

Business Name

WALTER RAY ELLISTON MD

Original Issue Date

07/24/2002

Effective Date

07/24/2002

Expiration Date

07/31/2005

City

WEST FRANKFORT

State

Zip

62896

County

FRANKLIN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006