DEREK W SMITH Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****30

License Status

NOT RENEWED

Business

First Name

DEREK

Middle

Last Name

SMITH

Business Name

DEREK W SMITH

Original Issue Date

08/13/2004

Effective Date

04/21/2014

Expiration Date

07/31/2017

City

GLENS FALLS

State

Zip

12801

County

NEW YORK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017