GLEN T FORTIER MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036069473

License Status

INACTIVE

Business

First Name

GLEN T

Last Name

FORTIER

Suffix

Business Name

GLEN T FORTIER MD

Original Issue Date

09/18/1984

Effective Date

09/18/1984

Expiration Date

07/31/1987

City

MICHIGAN CITY

State

Zip

46360

County

INDIANA

Ever Disciplined

LastModifiedDate

09/20/2006