MARTIN M PETITH MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036046281

License Status

INACTIVE

Business

First Name

MARTIN M

Last Name

PETITH

Suffix

Business Name

MARTIN M PETITH MD

Original Issue Date

08/17/1972

Effective Date

04/11/2011

Expiration Date

07/31/2014

City

CARBONDALE

State

Zip

62901

County

JACKSON

Ever Disciplined

LastModifiedDate

04/08/2014