EARL J BAUTISTA Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125028070

License Status

EXPIRED

Business

First Name

EARL

Middle

Last Name

BAUTISTA

Business Name

EARL J BAUTISTA

Original Issue Date

05/14/1992

Effective Date

05/14/1992

Expiration Date

06/21/1995

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006