BRENDAN M FONG MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****21

License Status

ACTIVE

Business

Title

First Name

BRENDAN

Middle

Last Name

FONG

Business Name

BRENDAN M FONG MD

Original Issue Date

09/02/2021

Effective Date

06/08/2023

Expiration Date

07/31/2026

City

O FALLON

State

Zip

62269

County

SAINT CLAIR

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/08/2023