NICHOLAS RAY FLORENCE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125067926

License Status

CANCELLED

Business

Title

First Name

NICHOLAS

Middle

RAY

Last Name

FLORENCE

Business Name

NICHOLAS RAY FLORENCE MD

Original Issue Date

07/01/2019

Effective Date

07/01/2019

Expiration Date

06/30/2020

City

BLOOMINGTON

State

Zip

61705

County

MCLEAN

Specialty/Qualifier

Diagnostic Radiology

Ever Disciplined

LastModifiedDate

02/11/2019