BRUCE DOUGLAS MALLATT MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036057517

License Status

NOT RENEWED

Business

First Name

BRUCE DOUGLAS

Last Name

MALLATT

Suffix

Business Name

BRUCE DOUGLAS MALLATT MD

Original Issue Date

08/21/1978

Effective Date

08/21/1978

City

CROWN POINT

State

Zip

46943

County

INDIANA

Ever Disciplined

LastModifiedDate

09/20/2006