JOSE FABRIZIO PORTUGAL GONZALES Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125074570

License Status

EXPIRED

Business

First Name

JOSE

Middle

FABRIZIO

Last Name

PORTUGAL GONZALES

Business Name

JOSE FABRIZIO PORTUGAL GONZALES

Original Issue Date

06/27/2019

Effective Date

06/27/2019

Expiration Date

06/26/2022

City

CHICAGO

State

Zip

60640

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

10/11/2022