DANA C FAIRBANKS Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125036261

License Status

EXPIRED

Business

First Name

DANA

Middle

Last Name

FAIRBANKS

Business Name

DANA C FAIRBANKS

Original Issue Date

05/21/1997

Effective Date

05/21/1997

Expiration Date

11/19/2003

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

09/22/2006