DANIEL LEE MONTGOMERY MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125061162

License Status

CANCELLED

Business

Title

First Name

DANIEL

Middle

LEE

Last Name

MONTGOMERY

Business Name

DANIEL LEE MONTGOMERY MD

Original Issue Date

07/01/2012

Effective Date

07/01/2012

Expiration Date

06/30/2015

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

03/24/2014