TAREQ ZAZA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****84

License Status

NOT RENEWED

Business

Title

First Name

TAREQ

Last Name

ZAZA

Business Name

TAREQ ZAZA MD

Original Issue Date

08/02/2012

Effective Date

06/21/2017

Expiration Date

09/30/2020

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021