CLINT JUSTIN BASENER DO - Medical Doctor License in Illinois | # 125047346

CLINT JUSTIN BASENER DO

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125047346

License Status

EXPIRED

Business

N

First Name

CLINT

Middle

JUSTIN

Last Name

BASENER

Suffix

DO

Business Name

CLINT JUSTIN BASENER DO

Original Issue Date

06/21/2004

Effective Date

06/21/2004

Expiration Date

06/20/2005

State

IL

Specialty/Qualifier

Rotating Internship

Ever Disciplined

N

LastModifiedDate

09/22/2006