ELLEN M MIDDENDORF Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125041039

License Status

EXPIRED

Business

First Name

ELLEN

Middle

Last Name

MIDDENDORF

Business Name

ELLEN M MIDDENDORF

Original Issue Date

07/01/2000

Effective Date

07/01/2000

Expiration Date

06/30/2003

City

BELLEVILLE

State

Zip

62220

County

SAINT CLAIR

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006