MANUEL F BAUTISTA MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125016916

License Status

EXPIRED

Business

First Name

MANUEL F

Last Name

BAUTISTA

Suffix

Business Name

MANUEL F BAUTISTA MD

Original Issue Date

06/22/1984

Effective Date

06/22/1984

Expiration Date

07/01/1986

City

SPRINGFIELD

State

Zip

62708

County

SANGAMON

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

09/22/2006