NICHOLAS JON MOUW MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125060627

License Status

EXPIRED

Business

First Name

NICHOLAS

Middle

JON

Last Name

MOUW

Suffix

Business Name

NICHOLAS JON MOUW MD

Original Issue Date

06/30/2014

Effective Date

06/30/2014

Expiration Date

06/29/2016

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

08/16/2016