TERRY ROBERT ROTH 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

TERRY ROBERT

Last Name

ROTH

Suffix

Business Name

TERRY ROBERT ROTH MD

Original Issue Date

01/01/1997

Effective Date

08/11/2017

Expiration Date

09/30/2020

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021