ROGER EVERETT PACKARD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

LIMITED MEDICAL TEMPORARY PERMIT

License Number

130000852

License Status

EXPIRED

Business

First Name

ROGER

Middle

EVERETT

Last Name

PACKARD

Business Name

ROGER EVERETT PACKARD

Original Issue Date

11/01/2010

Effective Date

11/01/2010

Expiration Date

11/30/2010

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Obstetrics & Gynecology

Ever Disciplined

LastModifiedDate

12/27/2010