BRIAN K RUSSELL MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125015576

License Status

EXPIRED

Business

First Name

BRIAN

Middle

Last Name

RUSSELL

Suffix

Business Name

BRIAN K RUSSELL MD

Original Issue Date

06/15/1983

Effective Date

06/15/1983

Expiration Date

07/01/1985

City

SPRINGFIELD

State

Zip

62708

County

SANGAMON

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

09/22/2006