DAVID W FAIRBANKS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****61

License Status

NOT RENEWED

Business

First Name

DAVID W

Last Name

FAIRBANKS

Suffix

Business Name

DAVID W FAIRBANKS MD

Original Issue Date

06/18/1997

Effective Date

06/18/1997

Expiration Date

07/31/1999

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006