JOHN BRADLEY FORTUNE Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****71

License Status

NOT RENEWED

Business

First Name

JOHN

Middle

BRADLEY

Last Name

FORTUNE

Business Name

JOHN BRADLEY FORTUNE

Original Issue Date

11/27/2001

Effective Date

11/27/2001

Expiration Date

07/31/2005

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006