TODD ANDREW DIEBOLD DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125065335

License Status

CANCELLED

Business

First Name

TODD

Middle

ANDREW

Last Name

DIEBOLD

Suffix

Business Name

TODD ANDREW DIEBOLD DO

Original Issue Date

06/26/2017

Effective Date

06/26/2017

Expiration Date

06/25/2019

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Obstetrics and Gynecology

Ever Disciplined

LastModifiedDate

04/04/2017