ROBERT WYATT 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

ROBERT

Middle

WYATT

Last Name

SMITH

Suffix

Business Name

ROBERT WYATT SMITH MD

Original Issue Date

09/06/2007

Effective Date

06/17/2008

Expiration Date

07/31/2011

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011