BRIAN D FAIRFAX MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036050441

License Status

NOT RENEWED

Business

First Name

BRIAN D

Last Name

FAIRFAX

Suffix

Business Name

BRIAN D FAIRFAX MD

Original Issue Date

01/30/1975

Effective Date

01/30/1975

City

PHOENIX

State

Zip

85006

County

ARIZONA

Ever Disciplined

LastModifiedDate

09/20/2006