LA TANYA DERIESE AUSTIN MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125058885

License Status

EXPIRED

Business

First Name

LA TANYA

Middle

DERIESE

Last Name

AUSTIN

Suffix

Business Name

LA TANYA DERIESE AUSTIN MD

Original Issue Date

07/01/2010

Effective Date

07/01/2010

Expiration Date

06/30/2013

City

MAYWOOD

State

Zip

60153

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

10/07/2013