JUSTIN KELLEY SPACKEY MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125052016

License Status

CANCELLED

Business

First Name

JUSTIN

Middle

KELLEY

Last Name

SPACKEY

Suffix

Business Name

JUSTIN KELLEY SPACKEY MD

Original Issue Date

07/01/2006

Effective Date

07/01/2006

Expiration Date

06/30/2009

City

MUNSTER

State

Zip

46321

Specialty/Qualifier

Diagnostic Radiology

Ever Disciplined

LastModifiedDate

09/22/2006