KELLY D SHRUM Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

LIMITED MEDICAL TEMPORARY PERMIT

License Number

130000299

License Status

EXPIRED

Business

First Name

KELLY

Middle

Last Name

SHRUM

Business Name

KELLY D SHRUM

Original Issue Date

09/29/1995

Effective Date

09/29/1995

Expiration Date

10/31/1996

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Specialty/Qualifier

Obstetrics & Gynecology

Ever Disciplined

LastModifiedDate

09/25/2006