MOHAMMAD MAHBOOB AZAM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****99

License Status

NOT RENEWED

Business

First Name

MOHAMMAD

Middle

MAHBOOB

Last Name

AZAM

Suffix

Business Name

MOHAMMAD MAHBOOB AZAM MD

Original Issue Date

02/25/2009

Effective Date

06/15/2011

Expiration Date

07/31/2014

City

CARBONDALE

State

Zip

62901

County

JACKSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014