THONG Q PHAM Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****71

License Status

NOT RENEWED

Business

First Name

THONG Q

Last Name

PHAM

Business Name

THONG Q PHAM

Original Issue Date

09/26/1988

Effective Date

09/26/1988

Expiration Date

07/31/2008

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011