BRUCE L ROTH Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125023883

License Status

EXPIRED

Business

First Name

BRUCE

Middle

Last Name

ROTH

Business Name

BRUCE L ROTH

Original Issue Date

05/19/1989

Effective Date

05/19/1989

Expiration Date

06/22/1992

City

CHICAGO

State

Zip

60615

County

COOK

Specialty/Qualifier

Family Practice & OMT

Ever Disciplined

LastModifiedDate

09/22/2006