GUILLERMO MAZA MALAVE MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125074511

License Status

EXPIRED

Business

Title

First Name

GUILLERMO

Last Name

MAZA MALAVE

Business Name

GUILLERMO MAZA MALAVE MD

Original Issue Date

06/26/2022

Effective Date

06/26/2022

Expiration Date

06/25/2024

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Otolaryngology

Ever Disciplined

LastModifiedDate

10/30/2024