SMITHA GRACE C SAMUEL MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125052368

License Status

CANCELLED

Business

Title

First Name

SMITHA GRACE

Middle

Last Name

SAMUEL

Business Name

SMITHA GRACE C SAMUEL MD

Original Issue Date

06/26/2007

Effective Date

06/26/2007

Expiration Date

06/25/2010

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

04/16/2007