BRIAN DAVID CARLSON - Medical Doctor License in Illinois | # 125052458

BRIAN DAVID CARLSON

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125052458

License Status

CANCELLED

Business

N

First Name

BRIAN

Middle

DAVID

Last Name

CARLSON

Business Name

BRIAN DAVID CARLSON

Original Issue Date

07/01/2008

Effective Date

07/01/2008

Expiration Date

06/30/2010

State

IL

Specialty/Qualifier

Family Medicine

Ever Disciplined

N

LastModifiedDate

05/14/2008