KIM E WYATT MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036106337

License Status

NOT RENEWED

Business

First Name

KIM

Middle

Last Name

WYATT

Suffix

Business Name

KIM E WYATT MD

Original Issue Date

02/21/2002

Effective Date

04/12/2017

Expiration Date

09/30/2020

City

SPRINGFIELD

State

Zip

62704

County

MORGAN

Ever Disciplined

LastModifiedDate

01/14/2021