ANTHONY M FERNANDEZ Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****51

License Status

NOT RENEWED

Business

First Name

ANTHONY

Middle

Last Name

FERNANDEZ

Business Name

ANTHONY M FERNANDEZ

Original Issue Date

06/17/2004

Effective Date

06/17/2004

Expiration Date

07/31/2008

City

PLAINFIELD

State

Zip

60544

County

WILL

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020