LACIE RENEE PETRO MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125050112

License Status

EXPIRED

Business

First Name

LACIE

Middle

RENEE

Last Name

PETRO

Suffix

Business Name

LACIE RENEE PETRO MD

Original Issue Date

06/24/2005

Effective Date

06/24/2005

Expiration Date

06/23/2008

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

06/26/2008