MARTIN W MIZENER Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125022394

License Status

EXPIRED

Business

First Name

MARTIN

Middle

Last Name

MIZENER

Business Name

MARTIN W MIZENER

Original Issue Date

05/14/1988

Effective Date

05/14/1988

Expiration Date

07/01/1991

City

PEORIA

State

Zip

61603

County

PEORIA

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006