ELLEN CLAIR BOUAZIZI MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125077482

License Status

EXPIRED

Business

Title

First Name

ELLEN

Middle

CLAIR

Last Name

BOUAZIZI

Business Name

ELLEN CLAIR BOUAZIZI MD

Original Issue Date

07/01/2021

Effective Date

07/01/2021

Expiration Date

06/30/2024

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Internal Medicine/Pediatrics

Ever Disciplined

LastModifiedDate

10/30/2024