GUSTAVO A SOSA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125056300

License Status

CANCELLED

Business

Title

First Name

GUSTAVO

Middle

Last Name

SOSA

Business Name

GUSTAVO A SOSA MD

Original Issue Date

06/26/2009

Effective Date

06/26/2009

Expiration Date

06/25/2012

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

05/01/2009