TERENCE LOU DALLO AGUSTIN MD - Medical Doctor License in Illinois | # 125050489

TERENCE LOU DALLO AGUSTIN MD

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125050489

License Status

EXPIRED

Business

N

First Name

TERENCE LOU

Middle

DALLO

Last Name

AGUSTIN

Suffix

MD

Business Name

TERENCE LOU DALLO AGUSTIN MD

Original Issue Date

10/20/2005

Effective Date

10/20/2005

Expiration Date

10/19/2008

State

IL

Specialty/Qualifier

Internal Medicine

Ever Disciplined

N

LastModifiedDate

11/05/2008