DIANA GOODWINE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125052658

License Status

CANCELLED

Business

Title

First Name

DIANA

Last Name

GOODWINE

Business Name

DIANA GOODWINE MD

Original Issue Date

06/25/2007

Effective Date

06/25/2007

Expiration Date

06/24/2010

City

CHICAGO

State

Zip

60622

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

05/15/2007