BO MARCUS GUSTAFSSON MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125072614

License Status

CANCELLED

Business

Title

First Name

Middle

MARCUS

Last Name

GUSTAFSSON

Business Name

BO MARCUS GUSTAFSSON MD

Original Issue Date

07/01/2018

Effective Date

07/01/2018

Expiration Date

06/30/2021

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

05/30/2018