BRYAN J KELLENBERGER MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125053762

License Status

CANCELLED

Business

First Name

BRYAN

Middle

Last Name

KELLENBERGER

Suffix

Business Name

BRYAN J KELLENBERGER MD

Original Issue Date

06/26/2007

Effective Date

06/26/2007

Expiration Date

06/25/2010

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

06/12/2007