SHANE TODD RUSSELL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036114059

License Status

NOT RENEWED

Business

First Name

SHANE

Middle

TODD

Last Name

RUSSELL

Suffix

Business Name

SHANE TODD RUSSELL MD

Original Issue Date

06/29/2005

Effective Date

07/31/2006

Expiration Date

07/31/2008

City

SAINT PAUL

State

Zip

55101

County

MINNESOTA

Ever Disciplined

LastModifiedDate

11/19/2008