CLINT JUSTIN BASENER DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125047346

License Status

EXPIRED

Business

First Name

CLINT

Middle

JUSTIN

Last Name

BASENER

Suffix

Business Name

CLINT JUSTIN BASENER DO

Original Issue Date

06/21/2004

Effective Date

06/21/2004

Expiration Date

06/20/2005

City

OLYMPIA FIELDS

State

Zip

60461

County

COOK

Specialty/Qualifier

Rotating Internship

Ever Disciplined

LastModifiedDate

09/22/2006