EBEN EZRA TUCKER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****48

License Status

NOT RENEWED

Business

First Name

EBEN

Middle

EZRA

Last Name

TUCKER

Suffix

Business Name

EBEN EZRA TUCKER MD

Original Issue Date

06/27/2018

Effective Date

06/27/2018

Expiration Date

09/30/2020

City

PEORIA

State

Zip

61636

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021