JULIE M PENA Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125035094

License Status

EXPIRED

Business

First Name

JULIE

Middle

Last Name

PENA

Business Name

JULIE M PENA

Original Issue Date

06/15/1996

Effective Date

06/15/1996

Expiration Date

06/17/2000

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

Dermatology

Ever Disciplined

LastModifiedDate

09/22/2006