DAVID E ROTH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****69

License Status

NOT RENEWED

Business

First Name

DAVID

Middle

Last Name

ROTH

Suffix

Business Name

DAVID E ROTH MD

Original Issue Date

08/19/2009

Effective Date

06/13/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60640

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017