ELYSSE TOM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****60

License Status

NOT RENEWED

Business

Title

First Name

ELYSSE

Last Name

TOM

Business Name

ELYSSE TOM MD

Original Issue Date

03/04/2021

Effective Date

03/04/2021

Expiration Date

07/31/2023

City

MOUNT VERNON

State

Zip

62864

County

JEFFERSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

11/30/2023