RICHARD JAMES BROSTROM Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****24

License Status

NOT RENEWED

Business

First Name

RICHARD

Middle

JAMES

Last Name

BROSTROM

Business Name

RICHARD JAMES BROSTROM

Original Issue Date

12/29/1998

Effective Date

12/29/1998

Expiration Date

07/31/1999

City

FREEPORT

State

Zip

61032

County

STEPHENSON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006