STACY W GRAY Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125039828

License Status

CANCELLED

Business

First Name

STACY

Middle

Last Name

GRAY

Business Name

STACY W GRAY

Original Issue Date

06/24/1999

Effective Date

06/24/1999

Expiration Date

06/23/2002

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006