GINA MARIE PONTIUS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125052624

License Status

CANCELLED

Business

Title

First Name

GINA

Middle

MARIE

Last Name

PONTIUS

Business Name

GINA MARIE PONTIUS MD

Original Issue Date

08/01/2010

Effective Date

08/01/2010

Expiration Date

07/31/2011

City

QUINCY

State

Zip

62301

County

ADAMS

Specialty/Qualifier

Sports Medicine (Family Practice)

Ever Disciplined

LastModifiedDate

06/11/2010