ANSEL T TJIN A TAM MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036130618

License Status

INACTIVE

Business

Title

First Name

ANSEL

Middle

Last Name

TJIN A TAM

Business Name

ANSEL T TJIN A TAM MD

Original Issue Date

06/21/2012

Effective Date

07/11/2017

Expiration Date

09/30/2020

City

LOUISVILLE

State

Zip

40205

County

KENTUCKY

Ever Disciplined

LastModifiedDate

04/05/2020