RALPH W TACK MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****94

License Status

CANCELLED

Business

First Name

RALPH W

Last Name

TACK

Suffix

Business Name

RALPH W TACK MD

Original Issue Date

03/22/2005

Effective Date

07/28/2008

Expiration Date

07/31/2011

City

NORMAL

State

Zip

61761

County

MCLEAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011