MARK B NISSENBAUM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036069655

License Status

NOT RENEWED

Business

First Name

MARK

Middle

Last Name

NISSENBAUM

Suffix

Business Name

MARK B NISSENBAUM MD

Original Issue Date

10/17/1984

Effective Date

05/16/2011

Expiration Date

07/31/2014

City

BIRMINGHAM

State

Zip

35216

County

ALABAMA

Ever Disciplined

LastModifiedDate

11/17/2014