TANNER LEA COLEGROVE 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

TANNER

Middle

LEA

Last Name

COLEGROVE

Suffix

Business Name

TANNER LEA COLEGROVE MD

Original Issue Date

05/31/2005

Effective Date

06/13/2023

Expiration Date

07/31/2026

City

LAKE FOREST

State

Zip

60045

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/13/2023