DANE J NICHOLS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036085600

License Status

NOT RENEWED

Business

First Name

DANE J

Last Name

NICHOLS

Suffix

Business Name

DANE J NICHOLS MD

Original Issue Date

11/06/1992

Effective Date

11/06/1992

Expiration Date

07/31/1999

City

PEORIA

State

Zip

61656

County

PEORIA

Ever Disciplined

LastModifiedDate

09/20/2006