LEROY D WOMBOLD MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****55

License Status

NOT RENEWED

Business

First Name

LEROY D

Last Name

WOMBOLD

Suffix

Business Name

LEROY D WOMBOLD MD

Original Issue Date

09/20/1985

Effective Date

09/20/1985

Expiration Date

07/31/1990

City

JERSEYVILLE

State

Zip

62052

County

JERSEY

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006