BRUCE DOUGLAS MALLATT MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****96

License Status

NOT RENEWED

Business

First Name

BRUCE DOUGLAS

Last Name

MALLATT

Suffix

Business Name

BRUCE DOUGLAS MALLATT MD

Original Issue Date

01/01/1997

Expiration Date

01/01/1997

City

SILVIS

State

Zip

61282

County

ROCK ISLAND

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006