MAOXIIM TELLEZ MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125048200

License Status

EXPIRED

Business

Title

First Name

MAOXIIM

Last Name

TELLEZ

Business Name

MAOXIIM TELLEZ MD

Original Issue Date

06/24/2004

Effective Date

06/24/2004

Expiration Date

06/23/2007

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

07/03/2007