RALPH W TACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****09

License Status

NOT RENEWED

Business

First Name

RALPH W

Last Name

TACK

Suffix

Business Name

RALPH W TACK MD

Original Issue Date

08/08/1988

Effective Date

08/08/1988

Expiration Date

07/31/2005

City

PONTIAC

State

Zip

61764

County

LIVINGSTON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011