KENTON LEE WATERBROOK Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****08

License Status

NOT RENEWED

Business

First Name

KENTON

Middle

LEE

Last Name

WATERBROOK

Business Name

KENTON LEE WATERBROOK

Original Issue Date

05/15/2008

Effective Date

05/15/2008

Expiration Date

07/31/2011

City

WILLIAMSTON

State

Zip

48895

County

LA SALLE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011