JERRY MARK SMITH MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125057987

License Status

EXPIRED

Business

First Name

JERRY

Middle

MARK

Last Name

SMITH

Suffix

Business Name

JERRY MARK SMITH MD

Original Issue Date

06/26/2013

Effective Date

06/26/2013

Expiration Date

06/25/2014

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Dermatology

Ever Disciplined

LastModifiedDate

03/13/2015