LANE I MOORE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

VISITING PHYSICIAN PERMIT

License Number

106000425

License Status

EXPIRED

Business

Title

First Name

LANE

Middle

Last Name

MOORE

Business Name

LANE I MOORE MD

Original Issue Date

05/23/2011

Effective Date

05/23/2011

Expiration Date

11/22/2011

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Ever Disciplined

LastModifiedDate

01/18/2012