FERNANDO ANTHONY CARBALLO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036084876

License Status

NOT RENEWED

Business

First Name

FERNANDO ANTHONY

Last Name

CARBALLO

Suffix

Business Name

FERNANDO ANTHONY CARBALLO MD

Original Issue Date

07/20/1992

Effective Date

07/13/2011

Expiration Date

07/31/2014

City

MILWAUKEE

State

Zip

53215

County

WISCONSIN

Ever Disciplined

LastModifiedDate

11/17/2014