EDWIN R BALLELOS - Medical Doctor License in Illinois | # 125027727

EDWIN R BALLELOS

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125027727

License Status

EXPIRED

Business

N

First Name

EDWIN

Middle

R

Last Name

BALLELOS

Business Name

EDWIN R BALLELOS

Original Issue Date

04/24/1992

Effective Date

04/24/1992

Expiration Date

06/30/1995

State

IL

Specialty/Qualifier

Pediatrics

Ever Disciplined

N

LastModifiedDate

09/22/2006