EDWARD P SOUTHERN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036090652

License Status

NOT RENEWED

Business

First Name

EDWARD P

Last Name

SOUTHERN

Suffix

Business Name

EDWARD P SOUTHERN MD

Original Issue Date

05/04/1995

Effective Date

05/04/1995

Expiration Date

07/31/1996

City

WAYZATA

State

Zip

55391

Ever Disciplined

LastModifiedDate

10/31/2006