MICHAEL LEROY BRUIN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****58

License Status

NOT RENEWED

Business

First Name

MICHAEL

Middle

LEROY

Last Name

BRUIN

Suffix

Business Name

MICHAEL LEROY BRUIN MD

Original Issue Date

06/28/2000

Effective Date

05/12/2014

Expiration Date

07/31/2017

City

DECATUR

State

Zip

62526

County

MACON

Controlled Substance Schedule

II III IV

Ever Disciplined

LastModifiedDate

11/01/2017