SHANE DAVID BUSH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036130782

License Status

NOT RENEWED

Business

Title

First Name

SHANE

Middle

DAVID

Last Name

BUSH

Business Name

SHANE DAVID BUSH MD

Original Issue Date

07/09/2012

Effective Date

07/09/2012

Expiration Date

07/31/2014

City

VALPARAISO

State

Zip

46385

Ever Disciplined

LastModifiedDate

11/17/2014