GORDON ANDREW FUQUA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****94

License Status

NOT RENEWED

Business

First Name

GORDON ANDREW

Last Name

FUQUA

Suffix

Business Name

GORDON ANDREW FUQUA MD

Original Issue Date

01/01/1997

Effective Date

07/28/2014

Expiration Date

07/31/2017

City

CRANSTON

State

Zip

02905

County

RHODE ISLAND

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017