ROBERT EDWARD STALLWORTH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****87

License Status

NOT RENEWED

Business

First Name

ROBERT EDWARD

Last Name

STALLWORTH

Suffix

Business Name

ROBERT EDWARD STALLWORTH MD

Original Issue Date

01/01/1997

Effective Date

06/27/2011

Expiration Date

07/31/2014

City

SPRINGFIELD

State

Zip

62781

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014