SAMUEL R DOMINGUEZ Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****51

License Status

NOT RENEWED

Business

First Name

SAMUEL

Middle

Last Name

DOMINGUEZ

Business Name

SAMUEL R DOMINGUEZ

Original Issue Date

02/19/2003

Effective Date

02/19/2003

Expiration Date

07/31/2005

City

CHICAGO

State

Zip

60637

County

COOK

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

10/09/2006