RALPH W TACK MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036077274

License Status

INACTIVE

Business

First Name

RALPH W

Last Name

TACK

Suffix

Business Name

RALPH W TACK MD

Original Issue Date

07/05/1988

Effective Date

07/28/2008

Expiration Date

07/31/2011

City

FREMONT

State

Zip

43420

Ever Disciplined

LastModifiedDate

04/07/2011