JOHN RYAN LIDVALL MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125058952

License Status

CANCELLED

Business

First Name

JOHN

Middle

RYAN

Last Name

LIDVALL

Suffix

Business Name

JOHN RYAN LIDVALL MD

Original Issue Date

07/09/2010

Effective Date

07/09/2010

Expiration Date

07/08/2013

City

PEORIA

State

Zip

61615

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

07/09/2010