ELIZABETH TATUM MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125074639

License Status

CANCELLED

Business

Title

First Name

ELIZABETH

Last Name

TATUM

Business Name

ELIZABETH TATUM MD

Original Issue Date

06/26/2019

Effective Date

06/26/2019

Expiration Date

06/25/2022

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

05/03/2019