JONATHAN D ELLEN MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036079370

License Status

INACTIVE

Business

First Name

JONATHAN

Middle

Last Name

ELLEN

Suffix

Business Name

JONATHAN D ELLEN MD

Original Issue Date

08/30/1989

Effective Date

08/30/1989

Expiration Date

07/31/1990

City

SPRINGFIELD

State

Zip

01103

Ever Disciplined

LastModifiedDate

04/26/2010