MISHA LEE TABER MARTINEZ 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

Title

First Name

MISHA

Middle

LEE TABER

Last Name

MARTINEZ

Business Name

MISHA LEE TABER MARTINEZ MD

Original Issue Date

01/24/2012

Effective Date

04/11/2017

Expiration Date

09/30/2020

City

GRANITE CITY

State

Zip

62040

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021