KENNETH O GREEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036037266

License Status

NOT RENEWED

Business

First Name

KENNETH O

Last Name

GREEN

Suffix

Business Name

KENNETH O GREEN MD

Original Issue Date

09/13/1961

Effective Date

04/14/2011

Expiration Date

07/31/2014

City

BELLEVILLE

State

Zip

62221

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

11/17/2014