SHANE S SPICER Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125044974

License Status

EXPIRED

Business

First Name

SHANE

Middle

Last Name

SPICER

Business Name

SHANE S SPICER

Original Issue Date

06/18/2002

Effective Date

06/18/2002

Expiration Date

06/17/2005

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

09/22/2006