FRED LEE CROCKETT JR MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036034482

License Status

INACTIVE

Business

First Name

FRED LEE

Last Name

CROCKETT JR

Suffix

Business Name

FRED LEE CROCKETT JR MD

Original Issue Date

03/19/1957

Effective Date

03/19/1957

Expiration Date

07/31/1999

City

DANVILLE

State

Zip

61832

County

VERMILION

Ever Disciplined

LastModifiedDate

09/20/2006