BURR R FONTAINE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036068479

License Status

NOT RENEWED

Business

First Name

BURR R

Last Name

FONTAINE

Suffix

Business Name

BURR R FONTAINE MD

Original Issue Date

04/02/1984

Effective Date

04/02/1984

Expiration Date

07/31/1990

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Ever Disciplined

LastModifiedDate

09/20/2006