MARK NORMAN GOODMAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036114433

License Status

NOT RENEWED

Business

First Name

MARK

Middle

NORMAN

Last Name

GOODMAN

Suffix

Business Name

MARK NORMAN GOODMAN MD

Original Issue Date

08/17/2005

Effective Date

07/31/2006

Expiration Date

07/31/2008

City

PROVIDENCE

State

Zip

02903

County

COOK

Ever Disciplined

LastModifiedDate

11/06/2008