RALPH EDWIN DEFOREST MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036036512

License Status

NOT RENEWED

Business

First Name

RALPH EDWIN

Last Name

DEFOREST

Suffix

Business Name

RALPH EDWIN DEFOREST MD

Original Issue Date

05/20/1960

Effective Date

05/20/1960

Expiration Date

07/31/2005

City

WILMETTE

State

Zip

60091

County

COOK

Ever Disciplined

LastModifiedDate

10/09/2006