MARY PATRICIA FORKIN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****91

License Status

NOT RENEWED

Business

First Name

MARY PATRICIA

Last Name

FORKIN

Suffix

Business Name

MARY PATRICIA FORKIN MD

Original Issue Date

01/21/1985

Effective Date

01/21/1985

Expiration Date

07/31/1987

City

FORREST

State

Zip

61741

County

LIVINGSTON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006