BRIAN LEE MARTIN DPM Podiatrist License verification

Business Entity

NOT RENEWED

License Type

Podiatrist

Description

LICENSED PODIATRY CONTROLLED SUBSTANCE

License Number

31*****24

License Status

NOT RENEWED

Business

Title

DPM

First Name

BRIAN

Middle

LEE

Last Name

MARTIN

Business Name

BRIAN LEE MARTIN DPM

Original Issue Date

10/03/2006

Effective Date

11/21/2006

Expiration Date

01/31/2009

City

FAIRVIEW HEIGHTS

State

Zip

62208

County

SAINT CLAIR

Specialty/Qualifier

PHARM DISTRIBUTOR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/17/2009