DOUGLAS PETER FORGIT MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036134674

License Status

NOT RENEWED

Business

Title

First Name

DOUGLAS

Middle

PETER

Last Name

FORGIT

Business Name

DOUGLAS PETER FORGIT MD

Original Issue Date

02/24/2014

Effective Date

07/09/2014

Expiration Date

07/31/2017

City

CARBONDALE

State

Zip

62901

County

JACKSON

Ever Disciplined

LastModifiedDate

11/01/2017