TIMOTHY W BOERSMA DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****74

License Status

NOT RENEWED

Business

Title

First Name

TIMOTHY

Middle

Last Name

BOERSMA

Business Name

TIMOTHY W BOERSMA DO

Original Issue Date

12/13/2010

Effective Date

05/18/2017

Expiration Date

09/30/2020

City

SHANNON

State

Zip

61078

County

GRUNDY

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021