JACQUELYN TARA BUSSE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036123373

License Status

NOT RENEWED

Business

First Name

JACQUELYN

Middle

TARA

Last Name

BUSSE

Suffix

Business Name

JACQUELYN TARA BUSSE MD

Original Issue Date

05/06/2009

Effective Date

05/06/2009

Expiration Date

07/31/2011

City

SANTA CRUZ

State

Zip

95060

Ever Disciplined

LastModifiedDate

11/14/2011