ROGER ADOLPH EWALD MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****79

License Status

NOT RENEWED

Business

First Name

ROGER ADOLPH

Last Name

EWALD

Suffix

Business Name

ROGER ADOLPH EWALD MD

Original Issue Date

01/01/1997

Effective Date

05/29/2008

Expiration Date

07/31/2011

City

MONTICELLO

State

Zip

61856

County

PIATT

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/12/2017