FLORIDA TABAQUE DY MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****21

License Status

NOT RENEWED

Business

Title

First Name

FLORIDA

Middle

TABAQUE

Last Name

Business Name

FLORIDA TABAQUE DY MD

Original Issue Date

01/01/1997

Effective Date

06/12/2014

Expiration Date

07/31/2017

City

NORTHBROOK

State

Zip

60062

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017