MISHA LEE TABER MARTINEZ MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036129509

License Status

NOT RENEWED

Business

Title

First Name

MISHA

Middle

LEE TABER

Last Name

MARTINEZ

Business Name

MISHA LEE TABER MARTINEZ MD

Original Issue Date

01/24/2012

Effective Date

04/12/2017

Expiration Date

09/30/2020

City

GRANITE CITY

State

Zip

62040

County

MADISON

Ever Disciplined

LastModifiedDate

01/14/2021