BRIAN DAVID FONG MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036097399

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

DAVID

Last Name

FONG

Suffix

Business Name

BRIAN DAVID FONG MD

Original Issue Date

03/13/1998

Effective Date

03/13/1998

Expiration Date

07/31/1999

City

CHICAGO

State

Zip

60611

County

COOK

Ever Disciplined

LastModifiedDate

09/20/2006