FREDERICK W CHURCH MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036044472

License Status

INACTIVE

Business

First Name

FREDERICK W

Last Name

CHURCH

Suffix

Business Name

FREDERICK W CHURCH MD

Original Issue Date

07/09/1971

Effective Date

07/15/2014

Expiration Date

07/31/2017

City

ROCKFORD

State

Zip

61114

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

04/12/2017