EDWARD J BONGIORNO DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036093331

License Status

NOT RENEWED

Business

First Name

EDWARD J

Last Name

BONGIORNO

Suffix

Business Name

EDWARD J BONGIORNO DO

Original Issue Date

06/27/1996

Effective Date

06/27/1996

Expiration Date

07/31/2005

City

MATTOON

State

Zip

61938

County

COLES

Ever Disciplined

LastModifiedDate

10/09/2006