KEVAN HEATH LONG Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125060368

License Status

EXPIRED

Business

First Name

KEVAN

Middle

HEATH

Last Name

LONG

Business Name

KEVAN HEATH LONG

Original Issue Date

07/01/2011

Effective Date

07/01/2011

Expiration Date

06/30/2014

City

BELLEVILLE

State

Zip

62220

County

SAINT CLAIR

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

03/13/2015