EDUARDO S ANTEZANO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125036596

License Status

EXPIRED

Business

First Name

EDUARDO

Middle

Last Name

ANTEZANO

Business Name

EDUARDO S ANTEZANO

Original Issue Date

06/11/1997

Effective Date

06/11/1997

Expiration Date

06/25/2000

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006