FE POBLETE FUENTES MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****16

License Status

NOT RENEWED

Business

First Name

Middle

POBLETE

Last Name

FUENTES

Suffix

Business Name

FE POBLETE FUENTES MD

Original Issue Date

04/28/1992

Effective Date

07/24/2014

Expiration Date

07/31/2017

City

MENARD

State

Zip

62259

County

RANDOLPH

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017