KODY DUANE DORMIRE DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125075539

License Status

CANCELLED

Business

Title

First Name

KODY

Middle

DUANE

Last Name

DORMIRE

Business Name

KODY DUANE DORMIRE DO

Original Issue Date

07/01/2020

Effective Date

07/01/2020

Expiration Date

06/30/2023

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Internal Medicine/Pediatrics

Ever Disciplined

LastModifiedDate

04/01/2020