BASSAM SOUFAN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****94

License Status

ACTIVE

Business

First Name

BASSAM

Last Name

SOUFAN

Suffix

Business Name

BASSAM SOUFAN MD

Original Issue Date

03/17/1989

Effective Date

08/29/2023

Expiration Date

07/31/2026

City

ROCKFORD

State

Zip

61114

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/29/2023