THEODORE W FORD MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****60

License Status

NOT RENEWED

Business

First Name

THEODORE W

Last Name

FORD

Suffix

Business Name

THEODORE W FORD MD

Original Issue Date

10/24/1989

Effective Date

07/01/2008

Expiration Date

07/31/2011

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011