KEVIN LEE WALTZ MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****99

License Status

NOT RENEWED

Business

First Name

KEVIN LEE

Last Name

WALTZ

Suffix

Business Name

KEVIN LEE WALTZ MD

Original Issue Date

10/16/1992

Effective Date

10/16/1992

Expiration Date

07/31/1993

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006