GRACIE W PACKWOOD MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

LIMITED MEDICAL TEMPORARY PERMIT

License Number

130000440

License Status

EXPIRED

Business

First Name

GRACIE

Middle

Last Name

PACKWOOD

Suffix

Business Name

GRACIE W PACKWOOD MD

Original Issue Date

02/15/1997

Effective Date

02/15/1997

Expiration Date

08/15/1999

City

EDWARDSVILLE

State

Zip

62025

County

MADISON

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/25/2006