DAVID LEE MATLOCK Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125051081

License Status

EXPIRED

Business

First Name

DAVID

Middle

LEE

Last Name

MATLOCK

Business Name

DAVID LEE MATLOCK

Original Issue Date

07/01/2006

Effective Date

07/01/2006

Expiration Date

06/30/2009

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

07/15/2009