JOSEPH P BAST - Medical Doctor License in Illinois | # 125047348

JOSEPH P BAST

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125047348

License Status

EXPIRED

Business

N

First Name

JOSEPH

Middle

P

Last Name

BAST

Business Name

JOSEPH P BAST

Original Issue Date

06/22/2004

Effective Date

06/22/2004

Expiration Date

06/21/2007

State

IL

Specialty/Qualifier

Internal Medicine

Ever Disciplined

N

LastModifiedDate

07/03/2007