BRENT A GRAHAM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****89

License Status

NOT RENEWED

Business

First Name

BRENT A

Last Name

GRAHAM

Suffix

Business Name

BRENT A GRAHAM MD

Original Issue Date

01/11/1991

Effective Date

01/11/1991

Expiration Date

07/31/1993

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Controlled Substance Schedule

II III

Ever Disciplined

LastModifiedDate

09/26/2006