DAVID B FAGAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****47

License Status

NOT RENEWED

Business

First Name

DAVID B

Last Name

FAGAN

Suffix

Business Name

DAVID B FAGAN MD

Original Issue Date

06/23/1993

Effective Date

06/23/1993

Expiration Date

07/31/1996

City

COLUMBIA

State

Zip

62236

County

MONROE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006