BASIL HUSAYN HAZIMAH DPM Podiatrist License verification

Business Entity

NOT RENEWED

License Type

Podiatrist

Description

LICENSED PODIATRY CONTROLLED SUBSTANCE

License Number

31*****89

License Status

NOT RENEWED

Business

First Name

BASIL

Middle

HUSAYN

Last Name

HAZIMAH

Suffix

DPM

Business Name

BASIL HUSAYN HAZIMAH DPM

Original Issue Date

06/03/2008

Effective Date

12/01/2008

Expiration Date

01/31/2011

City

CARBONDALE

State

Zip

62901

County

JACKSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/10/2011