CARLA F ORTIQUE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125019491

License Status

EXPIRED

Business

First Name

CARLA F

Last Name

ORTIQUE

Suffix

Business Name

CARLA F ORTIQUE MD

Original Issue Date

06/18/1986

Effective Date

06/18/1986

Expiration Date

07/01/1989

City

ROCKFORD

State

Zip

61107

County

BOONE

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006