JARROD CLARKE HENDERSON WALL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****96

License Status

NOT RENEWED

Business

Title

First Name

JARROD

Middle

CLARKE HENDERSON

Last Name

WALL

Business Name

JARROD CLARKE HENDERSON WALL MD

Original Issue Date

12/01/2011

Effective Date

12/01/2011

Expiration Date

07/31/2014

City

SPRINGFIELD

State

Zip

62769

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II IV

Ever Disciplined

LastModifiedDate

04/05/2020