EDWARD TERRANCE STEVENS MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036043060

License Status

INACTIVE

Business

First Name

EDWARD TERRANCE

Last Name

STEVENS

Suffix

Business Name

EDWARD TERRANCE STEVENS MD

Original Issue Date

12/18/1969

Effective Date

12/18/1969

Expiration Date

07/31/2005

City

KENOSHA

State

Zip

53140

County

WISCONSIN

Ever Disciplined

LastModifiedDate

10/09/2006