RUSSELL L MARTIN Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000520

License Status

NOT RENEWED

Business

First Name

RUSSELL L

Last Name

MARTIN

Business Name

RUSSELL L MARTIN

Original Issue Date

02/05/1993

Effective Date

12/14/2007

Expiration Date

03/01/2010

City

COOL RIDGE

State

Zip

25825

County

WEST VIRGINIA

Ever Disciplined

LastModifiedDate

04/01/2010