DOUGLAS K BASSO Podiatrist License verification

Business Entity

CANCELLED

License Type

Podiatrist

Description

TEMPORARY PODIATRIC PHYSICIAN

License Number

135000901

License Status

CANCELLED

Business

First Name

DOUGLAS

Middle

Last Name

BASSO

Business Name

DOUGLAS K BASSO

Original Issue Date

08/17/2015

Effective Date

07/01/2015

Expiration Date

07/01/2018

City

ALTON

State

Zip

62002

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

05/27/2016