KEITH L FABRIQUE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****15

License Status

ACTIVE

Business

First Name

KEITH L

Last Name

FABRIQUE

Suffix

Business Name

KEITH L FABRIQUE MD

Original Issue Date

01/01/1997

Effective Date

06/06/2023

Expiration Date

07/31/2026

City

DECATUR

State

Zip

62521

County

MACON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/06/2023