BRYAN LEE ANDERSON MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125061639

License Status

CANCELLED

Business

Title

First Name

BRYAN

Middle

LEE

Last Name

ANDERSON

Business Name

BRYAN LEE ANDERSON MD

Original Issue Date

07/01/2012

Effective Date

07/01/2012

Expiration Date

06/30/2015

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

03/24/2014