JUAN C DOMINGUEZ Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125034191

License Status

EXPIRED

Business

First Name

JUAN

Middle

Last Name

DOMINGUEZ

Business Name

JUAN C DOMINGUEZ

Original Issue Date

05/08/1996

Effective Date

05/08/1996

Expiration Date

06/30/1999

City

DECATUR

State

Zip

62526

County

MACON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006