SAMUEL R DOMINGUEZ Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036108618

License Status

NOT RENEWED

Business

First Name

SAMUEL

Middle

Last Name

DOMINGUEZ

Business Name

SAMUEL R DOMINGUEZ

Original Issue Date

02/19/2003

Effective Date

02/19/2003

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60615

County

COOK

Ever Disciplined

LastModifiedDate

10/09/2006