DEIDRE ERIN BASS DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036131064

License Status

NOT RENEWED

Business

Title

First Name

DEIDRE

Middle

ERIN

Last Name

BASS

Business Name

DEIDRE ERIN BASS DO

Original Issue Date

08/06/2012

Effective Date

08/06/2012

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60657

County

COOK

Ever Disciplined

LastModifiedDate

11/17/2014