MARK RUSSELL MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125072161

License Status

EXPIRED

Business

Title

First Name

MARK

Last Name

RUSSELL

Business Name

MARK RUSSELL MD

Original Issue Date

07/01/2021

Effective Date

07/01/2021

Expiration Date

06/30/2022

City

WOODRIDGE

State

Zip

60517

Specialty/Qualifier

Pathology - Anatomic and Clinical

Ever Disciplined

LastModifiedDate

10/11/2022