JOHN DOUGLAS DICKINSON DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125062397

License Status

CANCELLED

Business

Title

First Name

JOHN

Middle

DOUGLAS

Last Name

DICKINSON

Business Name

JOHN DOUGLAS DICKINSON DO

Original Issue Date

07/05/2012

Effective Date

07/05/2012

Expiration Date

07/04/2015

City

NORMAL

State

Zip

61761

County

MCLEAN

Specialty/Qualifier

Neurological Surgery

Ever Disciplined

LastModifiedDate

03/24/2014