VIRGINIA AGNES LONG DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125072104

License Status

EXPIRED

Business

Title

First Name

VIRGINIA

Middle

AGNES

Last Name

LONG

Business Name

VIRGINIA AGNES LONG DO

Original Issue Date

06/25/2018

Effective Date

06/25/2018

Expiration Date

06/24/2021

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

10/11/2022