BERNICE M FOKUM MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125076842

License Status

CANCELLED

Business

Title

First Name

BERNICE

Middle

Last Name

FOKUM

Business Name

BERNICE M FOKUM MD

Original Issue Date

06/24/2020

Effective Date

06/24/2020

Expiration Date

06/23/2023

City

SPRINGFIELD

State

Zip

62712

County

SANGAMON

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

05/27/2020