TIMOTHY DANIEL FAGEN DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

VISITING RESIDENT

License Number

188000459

License Status

NOT RENEWED

Business

Title

First Name

TIMOTHY

Middle

DANIEL

Last Name

FAGEN

Business Name

TIMOTHY DANIEL FAGEN DO

Original Issue Date

10/25/2013

Effective Date

10/25/2013

Expiration Date

04/24/2014

City

BELLEVILLE

State

Zip

62226

County

SAINT CLAIR

Specialty/Qualifier

Pathology

Ever Disciplined

LastModifiedDate

08/12/2014