JUSTIN MARK BROOKS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125057595

License Status

CANCELLED

Business

Title

First Name

JUSTIN

Middle

MARK

Last Name

BROOKS

Business Name

JUSTIN MARK BROOKS MD

Original Issue Date

06/26/2010

Effective Date

06/26/2010

Expiration Date

06/25/2013

City

SPRINGFIELD

State

Zip

62703

County

SANGAMON

Specialty/Qualifier

Diagnostic Radiology

Ever Disciplined

LastModifiedDate

05/04/2010