JEREMY B ROTH Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125026571

License Status

EXPIRED

Business

First Name

JEREMY

Middle

Last Name

ROTH

Business Name

JEREMY B ROTH

Original Issue Date

05/10/1991

Effective Date

05/10/1991

Expiration Date

06/23/1993

City

EVANSTON

State

Zip

60202

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006