SALLY Q TAN Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****12

License Status

NOT RENEWED

Business

First Name

SALLY Q

Last Name

TAN

Business Name

SALLY Q TAN

Original Issue Date

08/23/1995

Effective Date

08/23/1995

Expiration Date

07/31/1996

City

OAK LAWN

State

Zip

60453

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006