RUSSELL L BROCK Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125023267

License Status

EXPIRED

Business

First Name

RUSSELL

Middle

Last Name

BROCK

Business Name

RUSSELL L BROCK

Original Issue Date

04/19/1989

Effective Date

04/19/1989

Expiration Date

06/23/1992

City

CHICAGO

State

Zip

60631

County

COOK

Specialty/Qualifier

Family Practice & OMT

Ever Disciplined

LastModifiedDate

09/22/2006