JUSTIN DEAN MOODY DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125049395

License Status

CANCELLED

Business

First Name

JUSTIN

Middle

DEAN

Last Name

MOODY

Suffix

Business Name

JUSTIN DEAN MOODY DO

Original Issue Date

07/01/2005

Effective Date

07/01/2005

Expiration Date

06/30/2008

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

09/22/2006