EDWIN R LAFONTAINE Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125013363

License Status

EXPIRED

Business

First Name

EDWIN

Middle

Last Name

LAFONTAINE

Business Name

EDWIN R LAFONTAINE

Original Issue Date

07/24/1981

Effective Date

07/24/1981

Expiration Date

07/01/1983

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Addiction Psychiatry

Ever Disciplined

LastModifiedDate

09/22/2006