MATTHEW LEE DOMINGUEZ MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125063103

License Status

CANCELLED

Business

Title

First Name

MATTHEW

Middle

LEE

Last Name

DOMINGUEZ

Business Name

MATTHEW LEE DOMINGUEZ MD

Original Issue Date

06/24/2013

Effective Date

06/24/2013

Expiration Date

06/23/2016

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

03/24/2014