BRIAN ROBERT BRAAKSMA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****72

License Status

NOT RENEWED

Business

Title

First Name

BRIAN

Middle

ROBERT

Last Name

BRAAKSMA

Business Name

BRIAN ROBERT BRAAKSMA MD

Original Issue Date

03/26/2012

Effective Date

05/08/2017

Expiration Date

09/30/2020

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021