DAVID J FONTAINE DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036082279

License Status

NOT RENEWED

Business

First Name

DAVID J

Last Name

FONTAINE

Suffix

Business Name

DAVID J FONTAINE DO

Original Issue Date

04/05/1991

Effective Date

04/05/1991

Expiration Date

07/31/1993

City

CENTRALIA

State

Zip

62801

County

MARION

Ever Disciplined

LastModifiedDate

04/23/2007