SU AH BAE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125061534

License Status

EXPIRED

Business

First Name

Middle

Last Name

BAE

Suffix

Business Name

SU AH BAE MD

Original Issue Date

07/16/2012

Effective Date

07/16/2012

Expiration Date

07/15/2014

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

03/13/2015