BRENT A GRAHAM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036081967

License Status

NOT RENEWED

Business

First Name

BRENT A

Last Name

GRAHAM

Suffix

Business Name

BRENT A GRAHAM MD

Original Issue Date

12/29/1990

Effective Date

12/29/1990

Expiration Date

07/31/1993

City

SPRINGFIELD

State

Zip

62407

County

SANGAMON

Ever Disciplined

LastModifiedDate

09/20/2006