SANTIAGO FABIAN MOSCOSO MARTINEZ MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125060325

License Status

EXPIRED

Business

Title

First Name

SANTIAGO

Middle

FABIAN

Last Name

MOSCOSO MARTINEZ

Business Name

SANTIAGO FABIAN MOSCOSO MARTINEZ MD

Original Issue Date

07/01/2011

Effective Date

07/01/2011

Expiration Date

06/30/2014

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

03/13/2015