BRYAN JON PACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036125552

License Status

NOT RENEWED

Business

Title

First Name

BRYAN

Middle

JON

Last Name

PACK

Business Name

BRYAN JON PACK MD

Original Issue Date

04/22/2010

Effective Date

04/22/2010

Expiration Date

07/31/2011

City

GRAND RAPIDS

State

Zip

49512

County

MICHIGAN

Ever Disciplined

LastModifiedDate

11/14/2011