JERRY K POPHAM Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125018735

License Status

EXPIRED

Business

First Name

JERRY

Middle

Last Name

POPHAM

Business Name

JERRY K POPHAM

Original Issue Date

06/20/1985

Effective Date

06/20/1985

Expiration Date

07/01/1988

City

CHICAGO

State

Zip

60640

County

COOK

Specialty/Qualifier

Family Practice & OMT

Ever Disciplined

LastModifiedDate

09/22/2006