CHRIS TARA BULAON DELOS REYES MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125055774

License Status

CANCELLED

Business

Title

First Name

CHRIS

Middle

TARA BULAON

Last Name

DELOS REYES

Business Name

CHRIS TARA BULAON DELOS REYES MD

Original Issue Date

06/25/2009

Effective Date

06/25/2009

Expiration Date

06/24/2012

City

CHICAGO

State

Zip

60657

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

04/17/2012