LARRY ROBERT BERGSTROM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036066433

License Status

NOT RENEWED

Business

First Name

LARRY ROBERT

Last Name

BERGSTROM

Suffix

Business Name

LARRY ROBERT BERGSTROM MD

Original Issue Date

04/20/1983

Effective Date

04/20/1983

Expiration Date

07/31/1987

City

CANTON

State

Zip

61520

County

FULTON

Ever Disciplined

LastModifiedDate

09/20/2006