DOUGLAS BLAINE TIPPIN MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125035911

License Status

CANCELLED

Business

Title

First Name

DOUGLAS

Middle

BLAINE

Last Name

TIPPIN

Business Name

DOUGLAS BLAINE TIPPIN MD

Original Issue Date

05/09/1997

Effective Date

05/09/1997

Expiration Date

06/23/2000

City

CHICAGO

State

Zip

60637

County

COOK

Ever Disciplined

LastModifiedDate

02/26/2018