MARK DOUGLAS FORTE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****44

License Status

NOT RENEWED

Business

Title

First Name

MARK

Middle

DOUGLAS

Last Name

FORTE

Business Name

MARK DOUGLAS FORTE MD

Original Issue Date

12/13/2011

Effective Date

12/13/2011

Expiration Date

07/31/2014

City

SANTA MONICA

State

Zip

90404

County

CALIFORNIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014