BRIAN ROBERT LONG MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036109186

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

ROBERT

Last Name

LONG

Suffix

Business Name

BRIAN ROBERT LONG MD

Original Issue Date

05/06/2003

Effective Date

07/31/2006

Expiration Date

07/31/2008

City

CHICAGO

State

Zip

60607

County

COOK

Ever Disciplined

LastModifiedDate

11/06/2008