SAGUN GAUTAM MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125050019

License Status

CANCELLED

Business

First Name

SAGUN

Last Name

GAUTAM

Suffix

Business Name

SAGUN GAUTAM MD

Original Issue Date

06/27/2005

Effective Date

06/27/2005

Expiration Date

06/26/2008

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006