DONALD D VAN FOSSAN JR MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****35

License Status

NOT RENEWED

Business

First Name

DONALD

Middle

Last Name

VAN FOSSAN

Suffix

JR MD

Business Name

DONALD D VAN FOSSAN JR MD

Original Issue Date

06/21/1989

Effective Date

06/21/1989

Expiration Date

07/31/1993

City

SPRINGFIELD

State

Zip

62703

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006