BRIAN PATRICK GOMOLL MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125057056

License Status

CANCELLED

Business

Title

First Name

BRIAN

Middle

PATRICK

Last Name

GOMOLL

Business Name

BRIAN PATRICK GOMOLL MD

Original Issue Date

06/24/2009

Effective Date

06/24/2009

Expiration Date

06/23/2012

City

HINES

State

Zip

60141

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

06/18/2009