JENNIFER D MOORE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****66

License Status

CANCELLED

Business

First Name

JENNIFER

Middle

Last Name

MOORE

Suffix

Business Name

JENNIFER D MOORE MD

Original Issue Date

07/16/2002

Effective Date

07/16/2002

Expiration Date

07/31/2005

City

EVANSTON

State

Zip

60201

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006