MITRA SHAMS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125036748

License Status

CANCELLED

Business

First Name

MITRA

Last Name

SHAMS

Suffix

Business Name

MITRA SHAMS MD

Original Issue Date

06/16/1997

Effective Date

06/16/1997

Expiration Date

09/14/2000

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006