KHALLAD AHMAD FARES Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036096760

License Status

NOT RENEWED

Business

First Name

KHALLAD AHMAD

Last Name

FARES

Business Name

KHALLAD AHMAD FARES

Original Issue Date

10/01/1997

Effective Date

07/31/2006

Expiration Date

07/31/2008

City

RED BUD

State

Zip

62278

County

RANDOLPH

Ever Disciplined

LastModifiedDate

11/06/2008