KENNETH J BOOMGAARD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125043183

License Status

EXPIRED

Business

First Name

KENNETH

Middle

Last Name

BOOMGAARD

Business Name

KENNETH J BOOMGAARD

Original Issue Date

07/01/2001

Effective Date

07/01/2001

Expiration Date

06/30/2004

City

BELLEVILLE

State

Zip

62220

County

SAINT CLAIR

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006