BRANDON E BOURGEOUS Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125037960

License Status

EXPIRED

Business

First Name

BRANDON

Middle

Last Name

BOURGEOUS

Business Name

BRANDON E BOURGEOUS

Original Issue Date

05/26/1998

Effective Date

05/26/1998

Expiration Date

06/30/2002

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

Obstetrics & Gynecology

Ever Disciplined

LastModifiedDate

09/22/2006