JUANITA NING FONCHAM MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125074539

License Status

EXPIRED

Business

Title

First Name

JUANITA

Middle

NING

Last Name

FONCHAM

Business Name

JUANITA NING FONCHAM MD

Original Issue Date

07/01/2019

Effective Date

07/01/2019

Expiration Date

06/30/2022

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

10/11/2022