MARK S WALD 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

MARK S

Last Name

WALD

Suffix

Business Name

MARK S WALD MD

Original Issue Date

10/02/2012

Effective Date

08/11/2014

Expiration Date

07/31/2017

City

SPARTA

State

Zip

62286

County

RANDOLPH

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020