DOUGLAS S HAM DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125047529

License Status

EXPIRED

Business

Title

First Name

DOUGLAS

Middle

Last Name

HAM

Business Name

DOUGLAS S HAM DO

Original Issue Date

07/01/2004

Effective Date

07/01/2004

Expiration Date

06/30/2007

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

07/03/2007