ELIAS D TRACE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125072391

License Status

CANCELLED

Business

Title

First Name

ELIAS

Middle

Last Name

TRACE

Business Name

ELIAS D TRACE MD

Original Issue Date

06/26/2018

Effective Date

06/26/2018

Expiration Date

06/25/2021

City

SPRINGFIELD

State

Zip

62781

County

SANGAMON

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

05/23/2018