ANTHONY L FANGMAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****52

License Status

NOT RENEWED

Business

First Name

ANTHONY

Middle

Last Name

FANGMAN

Suffix

Business Name

ANTHONY L FANGMAN MD

Original Issue Date

09/30/1999

Effective Date

09/30/1999

Expiration Date

07/31/2002

City

PEORIA

State

Zip

61637

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006