TIMOTHY MARK POWELL MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125043865

License Status

EXPIRED

Business

First Name

TIMOTHY

Middle

MARK

Last Name

POWELL

Suffix

Business Name

TIMOTHY MARK POWELL MD

Original Issue Date

07/01/2002

Effective Date

07/01/2002

Expiration Date

06/30/2007

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

Urology

Ever Disciplined

LastModifiedDate

07/03/2007