DEREK S GREENE Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

LIMITED MEDICAL TEMPORARY PERMIT

License Number

130000340

License Status

EXPIRED

Business

First Name

DEREK

Middle

Last Name

GREENE

Business Name

DEREK S GREENE

Original Issue Date

08/01/1996

Effective Date

08/01/1996

Expiration Date

03/31/1997

City

ROCKFORD

State

Zip

61107

County

BOONE

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/25/2006