AMALIJA N FAIRBANKS MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125012697

License Status

EXPIRED

Business

First Name

AMALIJA N

Last Name

FAIRBANKS

Suffix

Business Name

AMALIJA N FAIRBANKS MD

Original Issue Date

06/17/1981

Effective Date

06/17/1981

Expiration Date

07/01/1983

City

CARBONDALE

State

Zip

62901

County

JACKSON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006