LAURA SUSAN MARTIN Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****21

License Status

NOT RENEWED

Business

First Name

LAURA

Middle

SUSAN

Last Name

MARTIN

Business Name

LAURA SUSAN MARTIN

Original Issue Date

08/14/2001

Effective Date

08/14/2001

Expiration Date

07/31/2005

City

ROCKFORD

State

Zip

61114

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006