KIMBERLY ELAINE FAGEN MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036144413

License Status

INACTIVE

Business

Title

First Name

KIMBERLY

Middle

ELAINE

Last Name

FAGEN

Business Name

KIMBERLY ELAINE FAGEN MD

Original Issue Date

09/28/2017

Effective Date

09/28/2017

Expiration Date

09/30/2020

City

SEMINOLE

State

Zip

33777

Ever Disciplined

LastModifiedDate

09/04/2020