TRENT DAVIS LEAVITT DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125065536

License Status

CANCELLED

Business

First Name

TRENT

Middle

DAVIS

Last Name

LEAVITT

Suffix

Business Name

TRENT DAVIS LEAVITT DO

Original Issue Date

07/01/2017

Effective Date

07/01/2017

Expiration Date

06/30/2018

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Internal Medicine/Pediatrics

Ever Disciplined

LastModifiedDate

04/03/2017