JACK CALVIN FAGAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036038260

License Status

NOT RENEWED

Business

First Name

JACK CALVIN

Last Name

FAGAN

Suffix

Business Name

JACK CALVIN FAGAN MD

Original Issue Date

12/12/1962

Effective Date

12/12/1962

Expiration Date

07/31/1990

City

NORTHRIDGE

State

Zip

91403

County

CALIFORNIA

Ever Disciplined

LastModifiedDate

09/20/2006