BRUCE DAVID LONG MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****06

License Status

NOT RENEWED

Business

First Name

BRUCE DAVID

Last Name

LONG

Suffix

Business Name

BRUCE DAVID LONG MD

Original Issue Date

12/18/1981

Effective Date

12/18/1981

Expiration Date

07/31/1984

City

CANTON

State

Zip

61520

County

FULTON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006