KIRK PATRICK MAXINO UY MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****61

License Status

CANCELLED

Business

Title

First Name

KIRK PATRICK

Middle

MAXINO

Last Name

Business Name

KIRK PATRICK MAXINO UY MD

Original Issue Date

08/08/2012

Effective Date

08/08/2012

Expiration Date

07/31/2014

City

KELSO

State

Zip

98626

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/08/2014