THERESA BARBRA TRACY MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****07

License Status

CANCELLED

Business

First Name

THERESA

Middle

BARBRA

Last Name

TRACY

Suffix

Business Name

THERESA BARBRA TRACY MD

Original Issue Date

10/13/1998

Effective Date

10/13/1998

Expiration Date

07/31/2005

City

PEKIN

State

Zip

61554

County

TAZEWELL

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006