TRAVIS RICHARD SMITH Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****53

License Status

ACTIVE

Business

First Name

TRAVIS

Middle

RICHARD

Last Name

SMITH

Business Name

TRAVIS RICHARD SMITH

Original Issue Date

08/11/2020

Effective Date

08/01/2023

Expiration Date

07/31/2026

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/01/2023