TIMOTHY J LONG Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125032081

License Status

EXPIRED

Business

First Name

TIMOTHY J

Last Name

LONG

Business Name

TIMOTHY J LONG

Original Issue Date

06/30/1994

Effective Date

06/30/1994

Expiration Date

06/30/1997

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006