WYATT C JAFFE 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

First Name

WYATT

Middle

Last Name

JAFFE

Business Name

WYATT C JAFFE

Original Issue Date

06/23/2004

Effective Date

04/17/2008

Expiration Date

07/31/2011

City

SKOKIE

State

Zip

60077

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011