MICHAEL LEE WATERS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125034696

License Status

CANCELLED

Business

First Name

MICHAEL

Middle

LEE

Last Name

WATERS

Suffix

Business Name

MICHAEL LEE WATERS MD

Original Issue Date

05/23/1996

Effective Date

05/23/1996

Expiration Date

06/30/1999

City

PEORIA

State

Zip

61603

County

PEORIA

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006