SHANNON RAE CONNOLLY DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125062201

License Status

CANCELLED

Business

Title

First Name

SHANNON

Middle

RAE

Last Name

CONNOLLY

Business Name

SHANNON RAE CONNOLLY DO

Original Issue Date

07/01/2012

Effective Date

07/01/2012

Expiration Date

06/30/2015

City

BERWYN

State

Zip

60402

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

03/24/2014