DEAN RYAN DAVIS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125071567

License Status

CANCELLED

Business

Title

First Name

DEAN

Middle

RYAN

Last Name

DAVIS

Business Name

DEAN RYAN DAVIS MD

Original Issue Date

08/02/2017

Effective Date

08/02/2017

Expiration Date

08/01/2020

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

08/02/2017