CHARLES B BRUYNTJENS JR MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****46

License Status

CANCELLED

Business

First Name

CHARLES

Middle

Last Name

BRUYNTJENS

Suffix

JR MD

Business Name

CHARLES B BRUYNTJENS JR MD

Original Issue Date

10/16/1997

Effective Date

10/16/1997

Expiration Date

07/31/2005

City

SILVIS

State

Zip

61282

County

ROCK ISLAND

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020