MARK MIHRAN DAVIDIAN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****59

License Status

CANCELLED

Business

Title

First Name

MARK

Middle

MIHRAN

Last Name

DAVIDIAN

Business Name

MARK MIHRAN DAVIDIAN MD

Original Issue Date

11/21/2011

Effective Date

11/21/2011

Expiration Date

07/31/2014

City

PEORIA

State

Zip

61614

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/08/2014