ALFONSE BAQUERO MD Athletics Professional License verification

Business Entity

NOT RENEWED

License Type

Athletics Professional

Description

ATHLETICS - LICENSED PHYSICIAN

License Number

002020140-0002

License Status

NOT RENEWED

Business

First Name

ALFONSE

Last Name

BAQUERO

Suffix

Business Name

ALFONSE BAQUERO MD

Original Issue Date

11/05/1975

Effective Date

11/05/1975

Expiration Date

11/05/1976

City

DANVILLE

State

Zip

61832

County

VERMILION

Ever Disciplined

LastModifiedDate

09/18/2006