ADAM RANDOLPH TRAVIS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125054307

License Status

CANCELLED

Business

Title

First Name

ADAM

Middle

RANDOLPH

Last Name

TRAVIS

Business Name

ADAM RANDOLPH TRAVIS MD

Original Issue Date

07/01/2009

Effective Date

07/01/2009

Expiration Date

06/30/2011

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Diagnostic Radiology

Ever Disciplined

LastModifiedDate

05/15/2009