JOSE MANUEL PENA MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125070535

License Status

EXPIRED

Business

Title

First Name

JOSE

Middle

MANUEL

Last Name

PENA

Business Name

JOSE MANUEL PENA MD

Original Issue Date

07/01/2017

Effective Date

07/01/2017

Expiration Date

07/31/2020

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

11/19/2020