TROY MATTHEW RUSSELL MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****04

License Status

NOT RENEWED

Business

Title

First Name

TROY

Middle

MATTHEW

Last Name

RUSSELL

Business Name

TROY MATTHEW RUSSELL MD

Original Issue Date

12/15/2022

Effective Date

12/15/2022

Expiration Date

07/31/2023

City

SALT LAKE CITY

State

Zip

84111

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

11/30/2023