RUTH DIANE MAYFORTH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****83

License Status

NOT RENEWED

Business

First Name

RUTH

Middle

DIANE

Last Name

MAYFORTH

Suffix

Business Name

RUTH DIANE MAYFORTH MD

Original Issue Date

07/19/2001

Effective Date

07/12/2011

Expiration Date

07/31/2014

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014