RALPH PATRICK BROADWATER Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125019411

License Status

EXPIRED

Business

First Name

RALPH PATRICK

Last Name

BROADWATER

Business Name

RALPH PATRICK BROADWATER

Original Issue Date

06/12/1986

Effective Date

06/12/1986

Expiration Date

07/01/1990

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006