AISHA GARGOM Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****70

License Status

NOT RENEWED

Business

First Name

AISHA

Last Name

GARGOM

Business Name

AISHA GARGOM

Original Issue Date

01/21/2010

Effective Date

06/25/2014

Expiration Date

07/31/2017

City

MARION

State

Zip

62959

County

WILLIAMSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017