THERESA KATHERINE MATTINGLY MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125064953

License Status

EXPIRED

Business

Title

First Name

THERESA

Middle

KATHERINE

Last Name

MATTINGLY

Business Name

THERESA KATHERINE MATTINGLY MD

Original Issue Date

06/26/2017

Effective Date

06/26/2017

Expiration Date

06/25/2018

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Dermatology

Ever Disciplined

LastModifiedDate

10/25/2018