AMY BLAKE SUSNOW MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036126904

License Status

NOT RENEWED

Business

Title

First Name

AMY

Middle

BLAKE

Last Name

SUSNOW

Business Name

AMY BLAKE SUSNOW MD

Original Issue Date

11/23/2010

Effective Date

11/23/2010

Expiration Date

07/31/2011

City

ST. LOUISVILLE

State

Zip

80027

County

COLORADO

Ever Disciplined

LastModifiedDate

11/14/2011