KATHLEEN ELLEN BRISCOE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****46

License Status

NOT RENEWED

Business

First Name

KATHLEEN

Middle

ELLEN

Last Name

BRISCOE

Suffix

Business Name

KATHLEEN ELLEN BRISCOE MD

Original Issue Date

01/29/2003

Effective Date

01/29/2003

Expiration Date

07/31/2005

City

MATTOON

State

Zip

61938

County

COLES

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006