DAVID W FAIRBANKS MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125034037

License Status

EXPIRED

Business

First Name

DAVID W

Last Name

FAIRBANKS

Suffix

Business Name

DAVID W FAIRBANKS MD

Original Issue Date

04/13/1996

Effective Date

04/13/1996

Expiration Date

04/30/1998

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

04/05/2013