JERRY M ANTONINI MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125042128

License Status

EXPIRED

Business

Title

First Name

JERRY

Middle

Last Name

ANTONINI

Business Name

JERRY M ANTONINI MD

Original Issue Date

08/14/2000

Effective Date

08/14/2000

Expiration Date

08/13/2003

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006