HAYTHAM EZZAT MARIA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****28

License Status

NOT RENEWED

Business

Title

First Name

HAYTHAM

Middle

EZZAT

Last Name

MARIA

Business Name

HAYTHAM EZZAT MARIA MD

Original Issue Date

11/27/2018

Effective Date

11/27/2018

Expiration Date

09/30/2020

City

ALTON

State

Zip

62002

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021