DARLENE E FOGG Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****47

License Status

CANCELLED

Business

First Name

DARLENE

Middle

Last Name

FOGG

Business Name

DARLENE E FOGG

Original Issue Date

06/19/2000

Effective Date

06/19/2000

Expiration Date

07/31/2002

City

CHICAGO

State

Zip

60631

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006