SAMUEL DAVID FAM DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****54

License Status

ACTIVE

Business

Title

First Name

SAMUEL

Middle

DAVID

Last Name

FAM

Business Name

SAMUEL DAVID FAM DO

Original Issue Date

01/22/2020

Effective Date

07/19/2023

Expiration Date

07/31/2026

City

CHICAGO

State

Zip

60602

County

NEW YORK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/19/2023