LACEY DIVELY MOY MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125056398

License Status

CANCELLED

Business

Title

First Name

LACEY

Middle

DIVELY

Last Name

MOY

Business Name

LACEY DIVELY MOY MD

Original Issue Date

07/01/2009

Effective Date

07/01/2009

Expiration Date

06/30/2012

City

SPRINGFIELD

State

Zip

62707

County

SANGAMON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

04/29/2009