MARK L TELLEZ MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036093356

License Status

NOT RENEWED

Business

First Name

MARK L

Last Name

TELLEZ

Suffix

Business Name

MARK L TELLEZ MD

Original Issue Date

07/01/1996

Effective Date

07/01/1996

Expiration Date

07/31/2002

City

FORT WORTH

State

Zip

76104

County

TEXAS

Ever Disciplined

LastModifiedDate

10/09/2006