DOMINIQUE CAROL D'SOUZA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125079129

License Status

CANCELLED

Business

Title

First Name

DOMINIQUE

Middle

CAROL

Last Name

D'SOUZA

Business Name

DOMINIQUE CAROL D'SOUZA MD

Original Issue Date

07/07/2021

Effective Date

07/07/2021

Expiration Date

07/06/2024

City

O'FALLON

State

Zip

62269

County

SAINT CLAIR

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

07/07/2021