FREDERICK AUGUSTUS GODLEY IV MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125075458

License Status

CANCELLED

Business

Title

First Name

FREDERICK

Middle

AUGUSTUS

Last Name

GODLEY IV

Business Name

FREDERICK AUGUSTUS GODLEY IV MD

Original Issue Date

06/24/2020

Effective Date

06/24/2020

Expiration Date

06/23/2023

City

CHICAGO

State

Zip

60637

Specialty/Qualifier

General Surgery

Ever Disciplined

LastModifiedDate

03/31/2020