LUKE RICHARD FREDERICK MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125059642

License Status

CANCELLED

Business

Title

First Name

LUKE

Middle

RICHARD

Last Name

FREDERICK

Business Name

LUKE RICHARD FREDERICK MD

Original Issue Date

06/26/2014

Effective Date

06/26/2014

Expiration Date

06/25/2016

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Specialty/Qualifier

Urology

Ever Disciplined

LastModifiedDate

03/24/2014