THOMAS JOHN THEOBALD MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036039362

License Status

NOT RENEWED

Business

First Name

THOMAS JOHN

Last Name

THEOBALD

Suffix

Business Name

THOMAS JOHN THEOBALD MD

Original Issue Date

08/17/1964

Effective Date

08/17/1964

Expiration Date

07/31/2005

City

STREATOR

State

Zip

61364

County

LA SALLE

Ever Disciplined

LastModifiedDate

10/09/2006