KEITH R SMITH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****44

License Status

NOT RENEWED

Business

First Name

KEITH R

Last Name

SMITH

Suffix

Business Name

KEITH R SMITH MD

Original Issue Date

07/23/1990

Effective Date

07/23/1990

Expiration Date

07/31/1993

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020