MARK W DE ROO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125013176

License Status

EXPIRED

Business

First Name

MARK

Middle

Last Name

DE ROO

Business Name

MARK W DE ROO

Original Issue Date

06/30/1981

Effective Date

06/30/1981

Expiration Date

07/01/1983

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006