MARY SUSAN BASOL KENNEDY MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036050464

License Status

NOT RENEWED

Business

First Name

MARY SUSAN BASOL

Last Name

KENNEDY

Suffix

Business Name

MARY SUSAN BASOL KENNEDY MD

Original Issue Date

01/30/1975

Effective Date

01/30/1975

City

MUSKOGEE

State

Zip

74401

County

OKLAHOMA

Ever Disciplined

LastModifiedDate

09/20/2006