MARK STEPHEN FASZHOLZ MD 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

MARK

Middle

STEPHEN

Last Name

FASZHOLZ

Suffix

Business Name

MARK STEPHEN FASZHOLZ MD

Original Issue Date

03/31/1997

Effective Date

03/31/1997

Expiration Date

07/31/2008

City

MOUNT VERNON

State

Zip

62864

County

JEFFERSON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011