TANIA VALSA MATHEW MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****97

License Status

NOT RENEWED

Business

Title

First Name

TANIA

Middle

VALSA

Last Name

MATHEW

Business Name

TANIA VALSA MATHEW MD

Original Issue Date

02/17/2017

Effective Date

05/17/2017

Expiration Date

09/30/2020

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021