TAMMY LYNN PROVATAS MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****54

License Status

ACTIVE

Business

Title

First Name

TAMMY

Middle

LYNN

Last Name

PROVATAS

Business Name

TAMMY LYNN PROVATAS MD

Original Issue Date

02/22/2024

Effective Date

02/22/2024

Expiration Date

07/31/2026

City

PITTSFIELD

State

Zip

62363

County

PIKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/22/2024