BRIAN KEITH PRIVETT MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125052950

License Status

EXPIRED

Business

First Name

BRIAN

Middle

KEITH

Last Name

PRIVETT

Suffix

Business Name

BRIAN KEITH PRIVETT 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

Internal Medicine

Ever Disciplined

LastModifiedDate

07/08/2010