JEAN A GUSTAFSON Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125016881

License Status

EXPIRED

Business

First Name

JEAN

Middle

Last Name

GUSTAFSON

Business Name

JEAN A GUSTAFSON

Original Issue Date

06/01/1984

Effective Date

06/01/1984

Expiration Date

07/01/1986

City

NORTH CHICAGO

State

Zip

60064

County

LAKE

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006