HUMPHREY CLARKE BOOTH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****71

License Status

NOT RENEWED

Business

First Name

HUMPHREY CLARKE

Last Name

BOOTH

Suffix

Business Name

HUMPHREY CLARKE BOOTH MD

Original Issue Date

03/31/1986

Effective Date

03/31/1986

Expiration Date

07/31/1987

City

BOURBONNAIS

State

Zip

60914

County

KANKAKEE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006