THOMAS G RUSSELL JR Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****63

License Status

NOT RENEWED

Business

First Name

THOMAS

Middle

Last Name

RUSSELL

Suffix

Business Name

THOMAS G RUSSELL JR

Original Issue Date

07/14/1995

Effective Date

07/14/1995

Expiration Date

07/31/1996

City

METROPOLIS

State

Zip

62960

County

MASSAC

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006