ERICH NATHANIEL SLOCUM DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125057822

License Status

CANCELLED

Business

Title

First Name

ERICH

Middle

NATHANIEL

Last Name

SLOCUM

Business Name

ERICH NATHANIEL SLOCUM DO

Original Issue Date

07/01/2010

Effective Date

07/01/2010

Expiration Date

06/30/2013

City

RANTOUL

State

Zip

61866

County

CHAMPAIGN

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

05/17/2010