LAURA SUSAN MARTIN Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036105066

License Status

NOT RENEWED

Business

First Name

LAURA

Middle

SUSAN

Last Name

MARTIN

Business Name

LAURA SUSAN MARTIN

Original Issue Date

06/27/2001

Effective Date

06/27/2001

Expiration Date

07/31/2005

City

ROCKFORD

State

Zip

61114

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

10/09/2006