JASON ANDREW ROTH Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125060683

License Status

EXPIRED

Business

First Name

JASON

Middle

ANDREW

Last Name

ROTH

Business Name

JASON ANDREW ROTH

Original Issue Date

07/18/2011

Effective Date

07/18/2011

Expiration Date

07/17/2012

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Rhinology Fellowship

Ever Disciplined

LastModifiedDate

08/29/2012