INGRID C ANTONSEN MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125020835

License Status

EXPIRED

Business

First Name

INGRID C

Last Name

ANTONSEN

Suffix

Business Name

INGRID C ANTONSEN MD

Original Issue Date

05/13/1987

Effective Date

05/13/1987

Expiration Date

07/01/1990

City

DECATUR

State

Zip

62521

County

MACON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006