CHARELLE OCTAVIA SMITH MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125073076

License Status

CANCELLED

Business

Title

First Name

CHARELLE

Middle

OCTAVIA

Last Name

SMITH

Business Name

CHARELLE OCTAVIA SMITH MD

Original Issue Date

07/01/2018

Effective Date

07/01/2018

Expiration Date

06/30/2021

City

CARBONDALE

State

Zip

62901

County

JACKSON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

06/06/2018