PHILIP CARLSON-DEXTER MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125070084

License Status

CANCELLED

Business

Title

First Name

PHILIP

Last Name

CARLSON-DEXTER

Business Name

PHILIP CARLSON-DEXTER MD

Original Issue Date

07/01/2017

Effective Date

07/01/2017

Expiration Date

06/30/2020

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

04/20/2017