MENA SAMWEL ISNASSUOS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****08

License Status

NOT RENEWED

Business

Title

First Name

MENA

Middle

SAMWEL

Last Name

ISNASSUOS

Business Name

MENA SAMWEL ISNASSUOS MD

Original Issue Date

02/08/2018

Effective Date

02/08/2018

Expiration Date

09/30/2020

City

SAINT LOUIS

State

Zip

63141

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021