TIMOTHY JAMES VON FANGE 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

Title

First Name

TIMOTHY

Middle

JAMES

Last Name

VON FANGE

Business Name

TIMOTHY JAMES VON FANGE MD

Original Issue Date

06/06/2008

Effective Date

06/06/2008

Expiration Date

07/31/2011

City

QUINCY

State

Zip

62301

County

ADAMS

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011