DEREK LEWIS TENNENHOUSE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****88

License Status

NOT RENEWED

Business

First Name

DEREK

Middle

LEWIS

Last Name

TENNENHOUSE

Suffix

Business Name

DEREK LEWIS TENNENHOUSE MD

Original Issue Date

08/03/2005

Effective Date

08/03/2005

Expiration Date

07/31/2008

City

SPARTA

State

Zip

62286

County

RANDOLPH

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

11/06/2008