JUAN RAFAEL MENDOZA ORTIZ MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125080147

License Status

CANCELLED

Business

Title

First Name

JUAN

Middle

RAFAEL

Last Name

MENDOZA ORTIZ

Business Name

JUAN RAFAEL MENDOZA ORTIZ MD

Original Issue Date

07/01/2022

Effective Date

07/01/2022

Expiration Date

06/30/2025

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

06/24/2025