ERIN E FANCHER GAGEN Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125044351

License Status

EXPIRED

Business

First Name

ERIN

Middle

Last Name

FANCHER GAGEN

Business Name

ERIN E FANCHER GAGEN

Original Issue Date

07/01/2002

Effective Date

07/01/2002

Expiration Date

06/30/2005

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006