DOUGLAS R PORT DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036114845

License Status

NOT RENEWED

Business

First Name

DOUGLAS

Middle

Last Name

PORT

Suffix

Business Name

DOUGLAS R PORT DO

Original Issue Date

11/07/2005

Effective Date

05/23/2014

Expiration Date

07/31/2017

City

SKOKIE

State

Zip

60077

County

COOK

Ever Disciplined

LastModifiedDate

11/01/2017