KEITH L FABRIQUE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036050458

License Status

ACTIVE

Business

First Name

KEITH L

Last Name

FABRIQUE

Suffix

Business Name

KEITH L FABRIQUE MD

Original Issue Date

01/30/1975

Effective Date

05/10/2023

Expiration Date

07/31/2026

City

DECATUR

State

Zip

62521

County

MACON

Ever Disciplined

LastModifiedDate

05/10/2023