BURT IRVIN BROMBERG MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****36

License Status

NOT RENEWED

Business

First Name

BURT IRVIN

Last Name

BROMBERG

Suffix

Business Name

BURT IRVIN BROMBERG MD

Original Issue Date

08/20/1997

Effective Date

06/15/2011

Expiration Date

07/31/2014

City

BELLEVILLE

State

Zip

62221

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014