CHARLES A BERGSTROM MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125017031

License Status

EXPIRED

Business

First Name

CHARLES A

Last Name

BERGSTROM

Suffix

Business Name

CHARLES A BERGSTROM MD

Original Issue Date

06/22/1984

Effective Date

06/22/1984

Expiration Date

07/01/1986

City

ROCKFORD

State

Zip

61107

County

BOONE

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006