DEAN J FONDAHN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****20

License Status

NOT RENEWED

Business

First Name

DEAN J

Last Name

FONDAHN

Suffix

Business Name

DEAN J FONDAHN MD

Original Issue Date

07/29/1999

Effective Date

06/26/2017

Expiration Date

09/30/2020

City

DIXON

State

Zip

61021

County

LEE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021