DYLAN JOSEPH DOUGLAS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125075528

License Status

CANCELLED

Business

Title

First Name

DYLAN

Middle

JOSEPH

Last Name

DOUGLAS

Business Name

DYLAN JOSEPH DOUGLAS MD

Original Issue Date

06/24/2020

Effective Date

06/24/2020

Expiration Date

06/23/2023

City

LAKE FOREST

State

Zip

60045

County

LAKE

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

04/01/2020