ANTHONY VINH PHAN DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125070903

License Status

CANCELLED

Business

Title

First Name

ANTHONY

Middle

VINH

Last Name

PHAN

Business Name

ANTHONY VINH PHAN DO

Original Issue Date

07/01/2017

Effective Date

07/01/2017

Expiration Date

06/30/2020

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

03/22/2017