TAMARA R FOUNTAIN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****68

License Status

ACTIVE

Business

First Name

TAMARA

Middle

Last Name

FOUNTAIN

Suffix

Business Name

TAMARA R FOUNTAIN MD

Original Issue Date

03/03/1998

Effective Date

04/20/2023

Expiration Date

07/31/2026

City

DEERFIELD

State

Zip

60015

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/20/2023