DEIDRE ERIN BASS DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****07

License Status

NOT RENEWED

Business

Title

First Name

DEIDRE

Middle

ERIN

Last Name

BASS

Business Name

DEIDRE ERIN BASS DO

Original Issue Date

08/06/2012

Effective Date

08/06/2012

Expiration Date

07/31/2014

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014