BRUCE JAY GARDNER MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125048312

License Status

EXPIRED

Business

Title

First Name

BRUCE

Middle

JAY

Last Name

GARDNER

Business Name

BRUCE JAY GARDNER MD

Original Issue Date

07/01/2004

Effective Date

07/01/2004

Expiration Date

06/30/2007

City

BELLEVILLE

State

Zip

62220

County

SAINT CLAIR

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

07/03/2007