DEREK W SMITH Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125042600

License Status

EXPIRED

Business

First Name

DEREK

Middle

Last Name

SMITH

Business Name

DEREK W SMITH

Original Issue Date

06/22/2001

Effective Date

06/22/2001

Expiration Date

06/21/2004

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006