EVANGELINE CO TAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****72

License Status

NOT RENEWED

Business

First Name

EVANGELINE

Middle

Last Name

TAN

Suffix

Business Name

EVANGELINE CO TAN MD

Original Issue Date

07/22/1998

Effective Date

04/11/2017

Expiration Date

09/30/2020

City

DANVILLE

State

Zip

61832

County

VERMILION

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021