MARY ELLEN MOORE DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125061971

License Status

CANCELLED

Business

Title

First Name

MARY

Middle

ELLEN

Last Name

MOORE

Business Name

MARY ELLEN MOORE DO

Original Issue Date

06/25/2012

Effective Date

06/25/2012

Expiration Date

06/24/2015

City

OAK LAWN

State

Zip

60453

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

03/24/2014