AMALIJA N FAIRBANKS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****87

License Status

NOT RENEWED

Business

First Name

AMALIJA N

Last Name

FAIRBANKS

Suffix

Business Name

AMALIJA N FAIRBANKS MD

Original Issue Date

05/03/1985

Effective Date

05/03/1985

Expiration Date

07/31/1993

City

ONARGA

State

Zip

60955

County

IROQUOIS

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006