ELLEN THERESA MCDERMOTT MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125049945

License Status

CANCELLED

Business

Title

First Name

ELLEN

Middle

THERESA

Last Name

MCDERMOTT

Business Name

ELLEN THERESA MCDERMOTT MD

Original Issue Date

07/01/2005

Effective Date

07/01/2005

Expiration Date

06/30/2008

City

BELLEVILLE

State

Zip

62220

County

SAINT CLAIR

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006