The holder whose full name is Douglas, James Gordon,come from Bloomington IN,hold the Temporary MD Permit license(NO.99045249A) which status is Superceded.
| Name | Douglas, James Gordon |
|---|---|
| License Number | 99045249A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Bloomington |
| State | IN |