ENRICO L MARTIN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****08

License Status

NOT RENEWED

Business

First Name

ENRICO

Middle

Last Name

MARTIN

Suffix

Business Name

ENRICO L MARTIN MD

Original Issue Date

07/03/2002

Effective Date

07/03/2002

Expiration Date

07/31/2008

City

ROCKFORD

State

Zip

61108

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011