MARK BENJAMIN FAMADOR MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125046684

License Status

EXPIRED

Business

First Name

MARK

Middle

BENJAMIN

Last Name

FAMADOR

Suffix

Business Name

MARK BENJAMIN FAMADOR MD

Original Issue Date

06/24/2003

Effective Date

06/24/2003

Expiration Date

06/23/2006

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

09/22/2006