SELINA A LONG Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125022109

License Status

EXPIRED

Business

First Name

SELINA

Middle

Last Name

LONG

Business Name

SELINA A LONG

Original Issue Date

05/11/1988

Effective Date

05/11/1988

Expiration Date

06/21/1991

City

WALPOLE

State

Zip

02081

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006