RUSSELL L MARTIN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****45

License Status

NOT RENEWED

Business

First Name

RUSSELL L

Last Name

MARTIN

Business Name

RUSSELL L MARTIN

Original Issue Date

08/08/2001

Effective Date

08/08/2001

Expiration Date

03/01/2002

City

DANVILLE

State

Zip

61832

County

VERMILION

Ever Disciplined

LastModifiedDate

10/09/2006