PHYLLIS MICHELLE TRUST DO - Medical Doctor License in Missouri | # 036102424

PHYLLIS MICHELLE TRUST DO

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036102424

License Status

INACTIVE

Business

N

First Name

PHYLLIS

Middle

MICHELLE

Last Name

TRUST

Suffix

DO

Business Name

PHYLLIS MICHELLE TRUST DO

Original Issue Date

05/03/2000

Effective Date

05/03/2000

Expiration Date

07/31/2002

State

MO

Ever Disciplined

N

LastModifiedDate

10/09/2006