MARTIN M PETITH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****78

License Status

NOT RENEWED

Business

First Name

MARTIN M

Last Name

PETITH

Suffix

Business Name

MARTIN M PETITH MD

Original Issue Date

05/10/1988

Effective Date

04/17/2008

Expiration Date

07/31/2011

City

CARBONDALE

State

Zip

62901

County

JACKSON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011