MARK D GERONIMO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****40

License Status

NOT RENEWED

Business

Title

First Name

MARK

Middle

Last Name

GERONIMO

Business Name

MARK D GERONIMO MD

Original Issue Date

08/25/2011

Effective Date

08/25/2011

Expiration Date

07/31/2014

City

BREESE

State

Zip

62230

County

CLINTON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014