GRACE TANDOC MARTIN Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****04

License Status

NOT RENEWED

Business

First Name

GRACE

Middle

TANDOC

Last Name

MARTIN

Business Name

GRACE TANDOC MARTIN

Original Issue Date

03/02/2000

Effective Date

03/02/2000

Expiration Date

07/31/2005

City

MAYWOOD

State

Zip

60153

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006