BASSAM SOUFAN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036077791

License Status

ACTIVE

Business

First Name

BASSAM

Last Name

SOUFAN

Suffix

Business Name

BASSAM SOUFAN MD

Original Issue Date

11/16/1988

Effective Date

08/29/2023

Expiration Date

07/31/2026

City

ROCKFORD

State

Zip

61114

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

08/29/2023

Case Number

1988002369

Action

Probation

Discipline Start Date

11/04/1988

Discipline End Date

05/04/1990