DEREK G KENNEASTER MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125029637

License Status

EXPIRED

Business

First Name

DEREK G

Last Name

KENNEASTER

Suffix

Business Name

DEREK G KENNEASTER MD

Original Issue Date

05/15/1993

Effective Date

05/15/1993

Expiration Date

06/30/1996

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006