ROBERT RANDOLPH WATERFORD MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****84

License Status

CANCELLED

Business

First Name

ROBERT

Middle

RANDOLPH

Last Name

WATERFORD

Suffix

Business Name

ROBERT RANDOLPH WATERFORD MD

Original Issue Date

08/06/2003

Effective Date

08/06/2003

Expiration Date

07/31/2005

City

CARBONDALE

State

Zip

62901

County

JACKSON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011