BERNARDITO FABRES SERVILLAS MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****34

License Status

CANCELLED

Business

First Name

BERNARDITO

Middle

FABRES

Last Name

SERVILLAS

Suffix

Business Name

BERNARDITO FABRES SERVILLAS MD

Original Issue Date

06/30/2004

Effective Date

06/30/2004

Expiration Date

07/31/2005

City

PEORIA

State

Zip

61603

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006