KEITH R SMITH MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125017745

License Status

EXPIRED

Business

First Name

KEITH R

Last Name

SMITH

Suffix

Business Name

KEITH R SMITH MD

Original Issue Date

12/28/1984

Effective Date

12/28/1984

Expiration Date

01/01/1987

City

SPRINGFIELD

State

Zip

62708

County

SANGAMON

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006