THOMAS EDWARD GREEN DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****24

License Status

CANCELLED

Business

First Name

THOMAS

Middle

EDWARD

Last Name

GREEN

Suffix

Business Name

THOMAS EDWARD GREEN DO

Original Issue Date

03/11/2011

Effective Date

04/21/2011

Expiration Date

07/31/2014

City

KANKAKEE

State

Zip

60901

County

KANKAKEE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/08/2014