BRIAN DAVID FONG MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****42

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

DAVID

Last Name

FONG

Suffix

Business Name

BRIAN DAVID FONG MD

Original Issue Date

07/16/1998

Effective Date

07/16/1998

Expiration Date

07/31/1999

City

CHICAGO

State

Zip

60611

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006