EZRA EDDY WYSSAM COHEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****74

License Status

NOT RENEWED

Business

First Name

EZRA EDDY

Middle

WYSSAM

Last Name

COHEN

Suffix

Business Name

EZRA EDDY WYSSAM COHEN MD

Original Issue Date

03/04/1999

Effective Date

07/11/2017

Expiration Date

09/30/2020

City

LA JOLLA

State

Zip

92093

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021