CAROLYN M MARTIN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****75

License Status

NOT RENEWED

Business

Title

First Name

CAROLYN

Middle

Last Name

MARTIN

Business Name

CAROLYN M MARTIN MD

Original Issue Date

02/28/2013

Effective Date

05/24/2017

Expiration Date

09/30/2020

City

MARYVILLE

State

Zip

62062

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021