MARIO D MIRANDA DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125033718

License Status

CANCELLED

Business

First Name

MARIO

Middle

Last Name

MIRANDA

Suffix

Business Name

MARIO D MIRANDA DO

Original Issue Date

07/01/1995

Effective Date

07/01/1995

Expiration Date

07/20/1998

City

PEORIA

State

Zip

61603

County

PEORIA

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006