MACK ANDELIN PETERSON DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125065274

License Status

EXPIRED

Business

Title

First Name

MACK

Middle

ANDELIN

Last Name

PETERSON

Business Name

MACK ANDELIN PETERSON DO

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