KERBY ASHLEY SAMUELS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125057719

License Status

CANCELLED

Business

First Name

KERBY

Middle

ASHLEY

Last Name

SAMUELS

Suffix

Business Name

KERBY ASHLEY SAMUELS MD

Original Issue Date

07/01/2010

Effective Date

07/01/2010

Expiration Date

06/30/2013

City

CHICAGO

State

Zip

60647

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

04/30/2010