RUSSELL MARTIN CARLSON DPM Podiatrist License verification

Business Entity

NOT RENEWED

License Type

Podiatrist

Description

LICENSED PODIATRY CONTROLLED SUBSTANCE

License Number

31*****16

License Status

NOT RENEWED

Business

Title

DPM

First Name

RUSSELL

Middle

MARTIN

Last Name

CARLSON

Business Name

RUSSELL MARTIN CARLSON DPM

Original Issue Date

04/29/2011

Effective Date

01/18/2019

Expiration Date

01/31/2021

City

MOLINE

State

Zip

61265

County

ROCK ISLAND

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/11/2021