JENNINE L LARSON Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125044322

License Status

EXPIRED

Business

First Name

JENNINE

Middle

Last Name

LARSON

Business Name

JENNINE L LARSON

Original Issue Date

05/03/2002

Effective Date

05/03/2002

Expiration Date

06/30/2007

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

07/03/2007