CHANNING S PETRAK Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125041236

License Status

EXPIRED

Business

First Name

CHANNING

Middle

Last Name

PETRAK

Business Name

CHANNING S PETRAK

Original Issue Date

07/01/2000

Effective Date

07/01/2000

Expiration Date

06/30/2003

City

PEORIA

State

Zip

61603

County

PEORIA

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006