JASON R MATTINGLY MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125039810

License Status

CANCELLED

Business

First Name

JASON

Middle

Last Name

MATTINGLY

Suffix

Business Name

JASON R MATTINGLY MD

Original Issue Date

07/01/1999

Effective Date

07/01/1999

Expiration Date

06/30/2002

City

PEORIA

State

Zip

61602

County

PEORIA

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006