TRACY LYNN LAWRENCE-BLACK MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****03

License Status

CANCELLED

Business

Title

First Name

TRACY

Middle

LYNN

Last Name

LAWRENCE-BLACK

Business Name

TRACY LYNN LAWRENCE-BLACK MD

Original Issue Date

07/11/2007

Effective Date

11/10/2008

Expiration Date

07/31/2011

City

WILMETTE

State

Zip

60091

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011