TED BROCKETT MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125013165

License Status

EXPIRED

Business

First Name

TED

Last Name

BROCKETT

Suffix

Business Name

TED BROCKETT MD

Original Issue Date

06/30/1981

Effective Date

06/30/1981

Expiration Date

07/01/1983

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006