BO T HEADLAM Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036115263

License Status

INACTIVE

Business

First Name

Middle

Last Name

HEADLAM

Business Name

BO T HEADLAM

Original Issue Date

02/21/2006

Effective Date

07/21/2014

Expiration Date

07/31/2017

City

PORTSMOUTH

State

Zip

45662

County

OHIO

Ever Disciplined

LastModifiedDate

04/12/2017