RICHARD E CARBALLO MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036082476

License Status

INACTIVE

Business

First Name

RICHARD E

Last Name

CARBALLO

Suffix

Business Name

RICHARD E CARBALLO MD

Original Issue Date

05/28/1991

Effective Date

05/28/1991

Expiration Date

07/31/1993

City

WAUWATOSA

State

Zip

52313

County

WISCONSIN

Ever Disciplined

LastModifiedDate

09/20/2006