H JAY BRUNINGA OD MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****73

License Status

NOT RENEWED

Business

First Name

H JAY

Last Name

BRUNINGA

Suffix

OD MD

Business Name

H JAY BRUNINGA OD MD

Original Issue Date

10/23/2008

Effective Date

10/23/2008

Expiration Date

07/31/2011

City

PITTSFIELD

State

Zip

62363

County

PIKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020