JACK THOMAS SANDFORD MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****40

License Status

NOT RENEWED

Business

First Name

JACK

Middle

THOMAS

Last Name

SANDFORD

Suffix

Business Name

JACK THOMAS SANDFORD MD

Original Issue Date

04/10/2001

Effective Date

04/25/2011

Expiration Date

07/31/2014

City

CARTERVILLE

State

Zip

62918

County

WILLIAMSON

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

11/17/2014