KIMBERLY E BROCKENBROUGH - Medical Doctor License in Illinois | # 125036157

KIMBERLY E BROCKENBROUGH

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125036157

License Status

EXPIRED

Business

N

First Name

KIMBERLY

Middle

E

Last Name

BROCKENBROUGH

Business Name

KIMBERLY E BROCKENBROUGH

Original Issue Date

05/19/1997

Effective Date

05/19/1997

Expiration Date

06/21/2002

State

IL

Specialty/Qualifier

Diagnostic Radiology

Ever Disciplined

N

LastModifiedDate

09/22/2006