JERELL DIEGO CHUA DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125056936

License Status

CANCELLED

Business

Title

First Name

JERELL

Middle

DIEGO

Last Name

CHUA

Business Name

JERELL DIEGO CHUA DO

Original Issue Date

07/01/2009

Effective Date

07/01/2009

Expiration Date

06/30/2012

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

06/05/2009