PHYLLIS MICHELLE TRUST DO Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036102424

License Status

INACTIVE

Business

First Name

PHYLLIS

Middle

MICHELLE

Last Name

TRUST

Suffix

Business Name

PHYLLIS MICHELLE TRUST DO

Original Issue Date

05/03/2000

Effective Date

05/03/2000

Expiration Date

07/31/2002

City

CLAYTON

State

Zip

63105

County

MISSOURI

Ever Disciplined

LastModifiedDate

10/09/2006