STACEY THAO PHAN DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125052039

License Status

EXPIRED

Business

First Name

STACEY

Middle

THAO

Last Name

PHAN

Suffix

Business Name

STACEY THAO PHAN DO

Original Issue Date

06/29/2006

Effective Date

06/29/2006

Expiration Date

06/28/2007

City

NORMAL

State

Zip

61761

County

MCLEAN

Specialty/Qualifier

Rotating Internship

Ever Disciplined

LastModifiedDate

07/03/2007