BRIAN DAVID CARLSON Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125052458

License Status

CANCELLED

Business

First Name

BRIAN

Middle

DAVID

Last Name

CARLSON

Business Name

BRIAN DAVID CARLSON

Original Issue Date

07/01/2008

Effective Date

07/01/2008

Expiration Date

06/30/2010

City

OLYMPIA FIELDS

State

Zip

60461

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

05/14/2008