JASON R FANGUSARO MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125039493

License Status

CANCELLED

Business

First Name

JASON

Middle

Last Name

FANGUSARO

Suffix

Business Name

JASON R FANGUSARO MD

Original Issue Date

06/28/1999

Effective Date

06/28/1999

Expiration Date

06/27/2002

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006