HENRY EDWIN RUSSELL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036059916

License Status

NOT RENEWED

Business

First Name

HENRY EDWIN

Last Name

RUSSELL

Suffix

Business Name

HENRY EDWIN RUSSELL MD

Original Issue Date

01/04/1980

Effective Date

01/04/1980

Expiration Date

07/31/1990

City

GALESBURG

State

Zip

61401

County

KNOX

Ever Disciplined

LastModifiedDate

09/20/2006