ANDREW DIAZ DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125077113

License Status

CANCELLED

Business

Title

First Name

ANDREW

Last Name

DIAZ

Business Name

ANDREW DIAZ 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

Ever Disciplined

LastModifiedDate

05/04/2020