BASMA AL-BAST MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125071536

License Status

CANCELLED

Business

Title

First Name

BASMA

Last Name

AL-BAST

Business Name

BASMA AL-BAST MD

Original Issue Date

06/30/2017

Effective Date

06/30/2017

Expiration Date

06/29/2020

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

06/30/2017