ASHLEY M JERATH-TATUM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****96

License Status

NOT RENEWED

Business

First Name

ASHLEY

Middle

Last Name

JERATH-TATUM

Suffix

Business Name

ASHLEY M JERATH-TATUM MD

Original Issue Date

04/28/2000

Effective Date

04/28/2000

Expiration Date

07/31/2002

City

DOWNERS GROVE

State

Zip

60515

County

DUPAGE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006