KHALLAD AHMAD FARES 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

KHALLAD AHMAD

Last Name

FARES

Business Name

KHALLAD AHMAD FARES

Original Issue Date

03/14/2003

Effective Date

03/14/2003

Expiration Date

07/31/2005

City

RED BUD

State

Zip

62278

County

RANDOLPH

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006