FORREST PENDLETON ALLEN DO - Medical Doctor License in Illinois | # 125062006

FORREST PENDLETON ALLEN DO

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125062006

License Status

CANCELLED

Business

N

Title

DO

First Name

FORREST

Middle

PENDLETON

Last Name

ALLEN

Business Name

FORREST PENDLETON ALLEN DO

Original Issue Date

06/25/2012

Effective Date

06/25/2012

Expiration Date

06/24/2015

State

IL

Specialty/Qualifier

Family Medicine

Ever Disciplined

N

LastModifiedDate

03/24/2014