ERIC DAVID TACK MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125013493

License Status

EXPIRED

Business

First Name

ERIC DAVID

Last Name

TACK

Suffix

Business Name

ERIC DAVID TACK MD

Original Issue Date

09/04/1981

Effective Date

09/04/1981

Expiration Date

07/01/1983

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006