DALE R MORTENSON Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125024160

License Status

EXPIRED

Business

First Name

DALE

Middle

Last Name

MORTENSON

Business Name

DALE R MORTENSON

Original Issue Date

06/21/1989

Effective Date

06/21/1989

Expiration Date

06/30/1993

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

Addiction Psychiatry

Ever Disciplined

LastModifiedDate

09/22/2006