WISSAM FOUAD DERIAN MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****59

License Status

ACTIVE

Business

First Name

WISSAM

Middle

FOUAD

Last Name

DERIAN

Suffix

Business Name

WISSAM FOUAD DERIAN MD

Original Issue Date

04/14/2005

Effective Date

04/18/2023

Expiration Date

07/31/2026

City

QUINCY

State

Zip

62301

County

ADAMS

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/18/2023