AMY S LARSON Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125039126

License Status

EXPIRED

Business

First Name

AMY

Middle

Last Name

LARSON

Business Name

AMY S LARSON

Original Issue Date

07/01/1999

Effective Date

07/01/1999

Expiration Date

06/30/2002

City

PEORIA

State

Zip

61603

County

PEORIA

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006