LARRY ROBERT BERGSTROM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****80

License Status

NOT RENEWED

Business

First Name

LARRY ROBERT

Last Name

BERGSTROM

Suffix

Business Name

LARRY ROBERT BERGSTROM MD

Original Issue Date

08/05/1983

Effective Date

08/05/1983

Expiration Date

07/31/1987

City

CANTON

State

Zip

61520

County

FULTON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006