SAMUEL FAHMY BARAK BOTROS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125050436

License Status

CANCELLED

Business

First Name

SAMUEL

Middle

FAHMY BARAK

Last Name

BOTROS

Suffix

Business Name

SAMUEL FAHMY BARAK BOTROS MD

Original Issue Date

07/05/2005

Effective Date

07/05/2005

Expiration Date

07/04/2008

City

BLOOMINGDALE

State

Zip

60108

Specialty/Qualifier

Obstetrics & Gynecology

Ever Disciplined

LastModifiedDate

09/22/2006