MARK PORVAZNIK DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125075306

License Status

EXPIRED

Business

Title

First Name

MARK

Last Name

PORVAZNIK

Business Name

MARK PORVAZNIK DO

Original Issue Date

09/09/2019

Effective Date

09/09/2019

Expiration Date

09/08/2020

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

11/24/2020