FARNAZ MOAZZAM Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****37

License Status

ACTIVE

Business

First Name

FARNAZ

Last Name

MOAZZAM

Business Name

FARNAZ MOAZZAM

Original Issue Date

12/11/2002

Effective Date

04/15/2023

Expiration Date

07/31/2026

City

PEKIN

State

Zip

61554

County

TAZEWELL

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/15/2023