CARLA F ORTIQUE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****25

License Status

NOT RENEWED

Business

First Name

CARLA F

Last Name

ORTIQUE

Suffix

Business Name

CARLA F ORTIQUE MD

Original Issue Date

01/19/1988

Effective Date

01/19/1988

Expiration Date

07/31/1993

City

ROCKFORD

State

Zip

61102

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006