HENRY WALTER PEMBERTON MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****86

License Status

NOT RENEWED

Business

First Name

HENRY WALTER

Last Name

PEMBERTON

Suffix

Business Name

HENRY WALTER PEMBERTON MD

Original Issue Date

10/05/1981

Effective Date

06/21/2011

Expiration Date

07/31/2014

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014