NASSIR HASSAN MONIM MANSOUR MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****86

License Status

NOT RENEWED

Business

Title

First Name

NASSIR

Middle

HASSAN MONIM

Last Name

MANSOUR

Business Name

NASSIR HASSAN MONIM MANSOUR MD

Original Issue Date

12/19/2013

Effective Date

12/11/2014

Expiration Date

07/31/2017

City

SPRINGFIELD

State

Zip

62703

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020