FERNANDO ANTHONY CARBALLO MD - Medical Doctor License in Wisconsin | # 036084876

FERNANDO ANTHONY CARBALLO MD

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036084876

License Status

NOT RENEWED

Business

N

First Name

FERNANDO ANTHONY

Last Name

CARBALLO

Suffix

MD

Business Name

FERNANDO ANTHONY CARBALLO MD

Original Issue Date

07/20/1992

Effective Date

07/13/2011

Expiration Date

07/31/2014

State

WI

Ever Disciplined

N

LastModifiedDate

11/17/2014