SAMUEL THEODORE LEE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125061701

License Status

EXPIRED

Business

Title

First Name

SAMUEL

Middle

THEODORE

Last Name

LEE

Business Name

SAMUEL THEODORE LEE 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

Pediatrics

Ever Disciplined

LastModifiedDate

09/04/2015