JENNIFER REAVIS DECKER MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125052503

License Status

CANCELLED

Business

Title

First Name

JENNIFER

Middle

REAVIS

Last Name

DECKER

Business Name

JENNIFER REAVIS DECKER MD

Original Issue Date

06/18/2010

Effective Date

06/18/2010

Expiration Date

06/17/2012

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Otolaryngology

Ever Disciplined

LastModifiedDate

01/13/2010