SAMUEL ROBERT NUSSBAUM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****39

License Status

NOT RENEWED

Business

First Name

SAMUEL ROBERT

Last Name

NUSSBAUM

Suffix

Business Name

SAMUEL ROBERT NUSSBAUM MD

Original Issue Date

12/29/1997

Effective Date

12/29/1997

Expiration Date

07/31/2002

City

FAIRVIEW HEIGHTS

State

Zip

62208

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011