PRESTON WAYNE DOUGLAS MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125065849

License Status

EXPIRED

Business

Title

First Name

PRESTON

Middle

WAYNE

Last Name

DOUGLAS

Business Name

PRESTON WAYNE DOUGLAS MD

Original Issue Date

06/23/2017

Effective Date

06/23/2017

Expiration Date

06/22/2018

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Neurology

Ever Disciplined

LastModifiedDate

10/25/2018