BRIAN DAVID FONG MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125035335

License Status

EXPIRED

Business

First Name

BRIAN

Middle

DAVID

Last Name

FONG

Suffix

Business Name

BRIAN DAVID FONG MD

Original Issue Date

07/02/1996

Effective Date

07/02/1996

Expiration Date

06/30/1999

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

09/22/2006