ERIC DAVID TACK MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036065103

License Status

INACTIVE

Business

First Name

ERIC DAVID

Last Name

TACK

Suffix

Business Name

ERIC DAVID TACK MD

Original Issue Date

08/13/1982

Effective Date

07/31/2008

Expiration Date

07/31/2011

City

PHOENIX

State

Zip

85064

County

ARIZONA

Ever Disciplined

LastModifiedDate

04/07/2011