STACY ANTOINETTE JEFFERSON MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125065259

License Status

EXPIRED

Business

Title

First Name

STACY

Middle

ANTOINETTE

Last Name

JEFFERSON

Business Name

STACY ANTOINETTE JEFFERSON MD

Original Issue Date

07/01/2014

Effective Date

07/01/2014

Expiration Date

06/30/2017

City

BELLEVILLE

State

Zip

62220

County

SAINT CLAIR

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/19/2017