DEIDRE ERIN BASS DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125057667

License Status

CANCELLED

Business

Title

First Name

DEIDRE

Middle

ERIN

Last Name

BASS

Business Name

DEIDRE ERIN BASS DO

Original Issue Date

06/21/2010

Effective Date

06/21/2010

Expiration Date

06/20/2013

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

05/11/2010