NICHOLAS G LEZAMA 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

First Name

NICHOLAS

Middle

Last Name

LEZAMA

Suffix

Business Name

NICHOLAS G LEZAMA MD

Original Issue Date

04/15/2008

Effective Date

04/15/2008

Expiration Date

07/31/2011

City

O FALLON

State

Zip

62269

County

SAINT CLAIR

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011