JANE E FOSSUM MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036094592

License Status

INACTIVE

Business

First Name

JANE E

Last Name

FOSSUM

Suffix

Business Name

JANE E FOSSUM MD

Original Issue Date

12/06/1996

Effective Date

06/16/2008

Expiration Date

07/31/2011

City

ROSCOE

State

Zip

61073

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

04/07/2011