JANE E FOSSUM MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****41

License Status

CANCELLED

Business

First Name

JANE E

Last Name

FOSSUM

Suffix

Business Name

JANE E FOSSUM MD

Original Issue Date

01/03/1997

Effective Date

06/16/2008

Expiration Date

07/31/2011

City

ROSCOE

State

Zip

61073

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011