KIM E WYATT MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125039241

License Status

EXPIRED

Business

First Name

KIM

Middle

Last Name

WYATT

Suffix

Business Name

KIM E WYATT MD

Original Issue Date

07/01/1999

Effective Date

07/01/1999

Expiration Date

06/30/2002

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006