KENNETH GERALD SMITH MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125029588

License Status

EXPIRED

Business

First Name

KENNETH

Middle

GERALD

Last Name

SMITH

Suffix

Business Name

KENNETH GERALD SMITH MD

Original Issue Date

05/12/1993

Effective Date

05/12/1993

Expiration Date

06/30/1998

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

Addiction Psychiatry

Ever Disciplined

LastModifiedDate

09/22/2006