THEODORE R FORD MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125022292

License Status

EXPIRED

Business

First Name

THEODORE R

Last Name

FORD

Suffix

Business Name

THEODORE R FORD MD

Original Issue Date

05/11/1988

Effective Date

05/11/1988

Expiration Date

06/19/1993

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Anesthesiology

Ever Disciplined

LastModifiedDate

09/22/2006