FARRAH NICOLE GASTON DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125077841

License Status

CANCELLED

Business

Title

First Name

FARRAH

Middle

NICOLE

Last Name

GASTON

Business Name

FARRAH NICOLE GASTON DO

Original Issue Date

07/01/2024

Effective Date

07/01/2024

Expiration Date

06/30/2025

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Internal Medicine/Pediatrics

Ever Disciplined

LastModifiedDate

04/23/2024