BRADLEY A BRENNER MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****25

License Status

NOT RENEWED

Business

First Name

BRADLEY

Middle

Last Name

BRENNER

Suffix

Business Name

BRADLEY A BRENNER MD

Original Issue Date

10/20/2000

Effective Date

10/20/2000

Expiration Date

07/31/2002

City

MARYVILLE

State

Zip

62062

County

MADISON

Controlled Substance Schedule

III IV

Ever Disciplined

LastModifiedDate

10/09/2006