PHILIP C BOULANGER Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125034079

License Status

EXPIRED

Business

First Name

PHILIP

Middle

Last Name

BOULANGER

Business Name

PHILIP C BOULANGER

Original Issue Date

05/02/1996

Effective Date

05/02/1996

Expiration Date

06/30/1999

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006