LARISSA RAE PAVONE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125051399

License Status

CANCELLED

Business

Title

First Name

LARISSA

Middle

RAE

Last Name

PAVONE

Business Name

LARISSA RAE PAVONE MD

Original Issue Date

06/19/2009

Effective Date

06/19/2009

Expiration Date

06/18/2010

City

WHEATON

State

Zip

60187

Specialty/Qualifier

Physical Medicine & Rehabilitation

Ever Disciplined

LastModifiedDate

04/01/2009