TIMOTHY LONG DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125056897

License Status

CANCELLED

Business

Title

First Name

TIMOTHY

Last Name

LONG

Business Name

TIMOTHY LONG DO

Original Issue Date

06/22/2009

Effective Date

06/22/2009

Expiration Date

06/21/2012

City

WINFIELD

State

Zip

60190

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

06/04/2009