JELRIZA CLAIRE B MANSOURI MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****53

License Status

NOT RENEWED

Business

First Name

JELRIZA CLAIRE

Middle

Last Name

MANSOURI

Suffix

Business Name

JELRIZA CLAIRE B MANSOURI MD

Original Issue Date

05/07/2012

Effective Date

05/07/2012

Expiration Date

07/31/2014

City

MT VERNON

State

Zip

62864

County

JEFFERSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014