TIFFANY J DIAZ MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125058224

License Status

CANCELLED

Business

Title

First Name

TIFFANY

Middle

Last Name

DIAZ

Business Name

TIFFANY J DIAZ MD

Original Issue Date

06/21/2010

Effective Date

06/21/2010

Expiration Date

06/20/2013

City

SCHAUMBURG

State

Zip

60194

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

07/08/2011