GERALD RICHARD FORTUNA JR 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

Title

First Name

GERALD

Middle

RICHARD

Last Name

FORTUNA

Suffix

Business Name

GERALD RICHARD FORTUNA JR MD

Original Issue Date

02/06/2018

Effective Date

08/06/2020

Expiration Date

07/31/2023

City

ST LOUIS

State

Zip

63110

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023