SAMUEL BAZ MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****52

License Status

NOT RENEWED

Business

First Name

SAMUEL

Last Name

BAZ

Suffix

Business Name

SAMUEL BAZ MD

Original Issue Date

10/03/2001

Effective Date

10/03/2001

Expiration Date

07/31/2005

City

WENONA

State

Zip

61377

County

LA SALLE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006