GORDON ANDREW FUQUA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036041997

License Status

NOT RENEWED

Business

First Name

GORDON ANDREW

Last Name

FUQUA

Suffix

Business Name

GORDON ANDREW FUQUA MD

Original Issue Date

08/01/1968

Effective Date

07/28/2014

Expiration Date

07/31/2017

City

CRANSTON

State

Zip

02905

County

RHODE ISLAND

Ever Disciplined

LastModifiedDate

11/01/2017