ANTHONY E FATHMAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****36

License Status

NOT RENEWED

Business

First Name

ANTHONY E

Last Name

FATHMAN

Suffix

Business Name

ANTHONY E FATHMAN MD

Original Issue Date

11/14/1996

Effective Date

11/14/1996

Expiration Date

07/31/2005

City

GRANITE CITY

State

Zip

62040

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011