TANNER LEA COLEGROVE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036113805

License Status

ACTIVE

Business

First Name

TANNER

Middle

LEA

Last Name

COLEGROVE

Suffix

Business Name

TANNER LEA COLEGROVE MD

Original Issue Date

05/27/2005

Effective Date

06/13/2023

Expiration Date

07/31/2026

City

LAKE FOREST

State

Zip

60045

County

LAKE

Ever Disciplined

LastModifiedDate

06/13/2023