JACQUELINE B PETRAVAGE MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036078721

License Status

INACTIVE

Business

First Name

JACQUELINE B

Last Name

PETRAVAGE

Suffix

Business Name

JACQUELINE B PETRAVAGE MD

Original Issue Date

04/15/1989

Effective Date

04/15/1989

Expiration Date

07/31/1990

City

CASPER

State

Zip

82601

County

WYOMING

Ever Disciplined

LastModifiedDate

09/20/2006