IVAN DIAZ MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125042320

License Status

EXPIRED

Business

First Name

IVAN

Last Name

DIAZ

Suffix

Business Name

IVAN DIAZ MD

Original Issue Date

04/25/2001

Effective Date

04/25/2001

Expiration Date

06/30/2004

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006