ERIC DAVID TACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****04

License Status

NOT RENEWED

Business

First Name

ERIC DAVID

Last Name

TACK

Suffix

Business Name

ERIC DAVID TACK MD

Original Issue Date

08/27/1982

Effective Date

08/27/1982

Expiration Date

07/31/1987

City

ST LOUIS

State

Zip

63141

County

MISSOURI

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011