KEITH LONGANH PHAM MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125048345

License Status

CANCELLED

Business

First Name

KEITH

Middle

LONGANH

Last Name

PHAM

Suffix

Business Name

KEITH LONGANH PHAM MD

Original Issue Date

06/10/2004

Effective Date

06/10/2004

Expiration Date

06/30/2007

City

STERLING

State

Zip

61081

Specialty/Qualifier

Diagnostic Radiology

Ever Disciplined

LastModifiedDate

09/22/2006