NIELS C ANDERSEN MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125014989

License Status

EXPIRED

Business

First Name

NIELS C

Last Name

ANDERSEN

Suffix

Business Name

NIELS C ANDERSEN MD

Original Issue Date

09/10/1982

Effective Date

09/10/1982

Expiration Date

06/28/1984

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006