KEITH T WILSON MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036078504

License Status

INACTIVE

Business

First Name

KEITH T

Last Name

WILSON

Suffix

Business Name

KEITH T WILSON MD

Original Issue Date

02/28/1989

Effective Date

02/28/1989

Expiration Date

07/31/1993

City

PHOENIX

State

Zip

21131

County

MARYLAND

Ever Disciplined

LastModifiedDate

09/20/2006