JAMES E PROVO MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125025229

License Status

EXPIRED

Business

First Name

JAMES E

Last Name

PROVO

Suffix

Business Name

JAMES E PROVO MD

Original Issue Date

05/29/1990

Effective Date

05/29/1990

Expiration Date

06/22/1993

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

09/22/2006