GRACE ELAINE FOWLER DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125037529

License Status

EXPIRED

Business

First Name

GRACE

Middle

ELAINE

Last Name

FOWLER

Suffix

Business Name

GRACE ELAINE FOWLER DO

Original Issue Date

05/07/1998

Effective Date

05/07/1998

Expiration Date

06/30/2001

City

PEORIA

State

Zip

61637

County

PEORIA

Ever Disciplined

LastModifiedDate

09/22/2006