BROOKE N BALLARD MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125043998

License Status

EXPIRED

Business

Title

First Name

BROOKE

Middle

Last Name

BALLARD

Business Name

BROOKE N BALLARD MD

Original Issue Date

04/23/2002

Effective Date

04/23/2002

Expiration Date

06/30/2005

City

DECATUR

State

Zip

62526

County

MACON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006