MARK WALTER DEROO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****76

License Status

NOT RENEWED

Business

First Name

MARK WALTER

Last Name

DEROO

Suffix

Business Name

MARK WALTER DEROO MD

Original Issue Date

12/09/1982

Effective Date

12/09/1982

Expiration Date

07/31/1984

City

PEORIA

State

Zip

61637

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006