DERRICK CLIFTON UMPHLETT MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125045444

License Status

CANCELLED

Business

First Name

DERRICK

Middle

CLIFTON

Last Name

UMPHLETT

Suffix

Business Name

DERRICK CLIFTON UMPHLETT MD

Original Issue Date

10/01/2002

Effective Date

10/01/2002

Expiration Date

09/30/2003

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

09/22/2006