LARA JOSAN THEOBALD MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036117149

License Status

NOT RENEWED

Business

First Name

LARA

Middle

JOSAN

Last Name

THEOBALD

Suffix

Business Name

LARA JOSAN THEOBALD MD

Original Issue Date

11/08/2006

Effective Date

05/16/2008

Expiration Date

07/31/2011

City

NAPERVILLE

State

Zip

60563

County

DUPAGE

Ever Disciplined

LastModifiedDate

11/14/2011