R DOUGLAS SPAFFORD Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****18

License Status

NOT RENEWED

Business

First Name

Middle

DOUGLAS

Last Name

SPAFFORD

Business Name

R DOUGLAS SPAFFORD

Original Issue Date

03/16/2001

Effective Date

03/03/2020

Expiration Date

03/01/2022

City

MARYVILLE

State

Zip

62062

County

MADISON

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022