TAMARA R FOUNTAIN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****81

License Status

NOT RENEWED

Business

First Name

TAMARA

Middle

Last Name

FOUNTAIN

Suffix

Business Name

TAMARA R FOUNTAIN MD

Original Issue Date

12/18/1997

Effective Date

12/18/1997

Expiration Date

07/31/1999

City

BOLINGBROOK

State

Zip

60440

County

WILL

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020