NEIL JAY NUSBAUM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****62

License Status

NOT RENEWED

Business

First Name

NEIL

Middle

JAY

Last Name

NUSBAUM

Suffix

Business Name

NEIL JAY NUSBAUM MD

Original Issue Date

03/14/2003

Effective Date

03/14/2003

Expiration Date

07/31/2008

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020