WALTER CLARK BOUTWELL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****93

License Status

NOT RENEWED

Business

First Name

WALTER

Middle

CLARK

Last Name

BOUTWELL

Suffix

Business Name

WALTER CLARK BOUTWELL MD

Original Issue Date

11/08/2013

Effective Date

11/08/2013

Expiration Date

07/31/2014

City

MCHENRY

State

Zip

60050

County

MCHENRY

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020