TARA ELAINE HUMPHREY DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125065076

License Status

CANCELLED

Business

Title

First Name

TARA

Middle

ELAINE

Last Name

HUMPHREY

Business Name

TARA ELAINE HUMPHREY DO

Original Issue Date

06/24/2014

Effective Date

06/24/2014

Expiration Date

06/23/2017

City

OAK LAWN

State

Zip

60453

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/08/2016