BRIAN K RUSSELL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036078323

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

Last Name

RUSSELL

Suffix

Business Name

BRIAN K RUSSELL MD

Original Issue Date

01/10/1989

Effective Date

04/12/2017

Expiration Date

09/30/2020

City

THOMASVILLE

State

Zip

31792

County

SANGAMON

Ever Disciplined

LastModifiedDate

01/14/2021