LATHA M BRUBAKER Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125040365

License Status

EXPIRED

Business

First Name

LATHA

Middle

Last Name

BRUBAKER

Business Name

LATHA M BRUBAKER

Original Issue Date

07/01/1999

Effective Date

07/01/1999

Expiration Date

06/30/2002

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006