DERRICK ALAN MONTGOMERY MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125045534

License Status

EXPIRED

Business

First Name

DERRICK

Middle

ALAN

Last Name

MONTGOMERY

Suffix

Business Name

DERRICK ALAN MONTGOMERY MD

Original Issue Date

04/17/2003

Effective Date

04/17/2003

Expiration Date

06/30/2006

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Ophthalmology

Ever Disciplined

LastModifiedDate

09/22/2006