KELVIN DWAYNE SHEPHERD DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125042709

License Status

EXPIRED

Business

First Name

KELVIN

Middle

DWAYNE

Last Name

SHEPHERD

Suffix

Business Name

KELVIN DWAYNE SHEPHERD DO

Original Issue Date

07/01/2001

Effective Date

07/01/2001

Expiration Date

06/30/2004

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006