PHILLIP WAYNE JANSEN DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125039318

License Status

EXPIRED

Business

First Name

PHILLIP

Middle

WAYNE

Last Name

JANSEN

Suffix

Business Name

PHILLIP WAYNE JANSEN DO

Original Issue Date

07/01/1999

Effective Date

07/01/1999

Expiration Date

06/30/2002

City

QUINCY

State

Zip

62301

County

ADAMS

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006