MARTIN GRISSOM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****85

License Status

NOT RENEWED

Business

First Name

MARTIN

Last Name

GRISSOM

Suffix

Business Name

MARTIN GRISSOM MD

Original Issue Date

10/19/2017

Effective Date

10/19/2017

Expiration Date

09/30/2020

City

SPRINGFIELD

State

Zip

62781

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021