BRIAN C FORT MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125059752

License Status

EXPIRED

Business

Title

First Name

BRIAN

Middle

Last Name

FORT

Business Name

BRIAN C FORT MD

Original Issue Date

06/27/2011

Effective Date

06/27/2011

Expiration Date

06/26/2014

City

OAK LAWN

State

Zip

60453

County

COOK

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

03/13/2015