JAY L LISS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****79

License Status

CANCELLED

Business

First Name

JAY L

Last Name

LISS

Suffix

Business Name

JAY L LISS MD

Original Issue Date

08/02/1995

Effective Date

08/02/1995

Expiration Date

07/31/2005

City

CHESTER

State

Zip

62233

County

RANDOLPH

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006