KENYATTA JAMAL FRAZIER MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125060060

License Status

CANCELLED

Business

Title

First Name

KENYATTA

Middle

JAMAL

Last Name

FRAZIER

Business Name

KENYATTA JAMAL FRAZIER MD

Original Issue Date

06/24/2011

Effective Date

06/24/2011

Expiration Date

06/23/2014

City

TRAVERSE CITY

State

Zip

49696

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

03/24/2014