GAYLORD MARTIN EDVENSON MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****15

License Status

CANCELLED

Business

First Name

GAYLORD MARTIN

Last Name

EDVENSON

Suffix

Business Name

GAYLORD MARTIN EDVENSON MD

Original Issue Date

01/01/1997

Expiration Date

07/31/2002

City

CHICAGO

State

Zip

60646

County

COOK

Controlled Substance Schedule

II III

Ever Disciplined

LastModifiedDate

10/09/2006