TAMMY LYNN PROVATAS MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036151319

License Status

ACTIVE

Business

Title

First Name

TAMMY

Middle

LYNN

Last Name

PROVATAS

Business Name

TAMMY LYNN PROVATAS MD

Original Issue Date

12/06/2019

Effective Date

04/11/2023

Expiration Date

07/31/2026

City

TWIN LAKE

State

Zip

49457

Ever Disciplined

LastModifiedDate

07/10/2023