SAMUEL R DOMINGUEZ Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125041081

License Status

EXPIRED

Business

First Name

SAMUEL

Middle

Last Name

DOMINGUEZ

Business Name

SAMUEL R DOMINGUEZ

Original Issue Date

06/24/2000

Effective Date

06/24/2000

Expiration Date

06/30/2003

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006