DAMON MARCUS DERTINA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125047449

License Status

CANCELLED

Business

First Name

DAMON

Middle

MARCUS

Last Name

DERTINA

Suffix

Business Name

DAMON MARCUS DERTINA MD

Original Issue Date

07/01/2004

Effective Date

07/01/2004

Expiration Date

06/30/2007

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Anesthesiology

Ever Disciplined

LastModifiedDate

09/22/2006