BRENT LEE CLYDE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036147630

License Status

NOT RENEWED

Business

Title

First Name

BRENT

Middle

LEE

Last Name

CLYDE

Business Name

BRENT LEE CLYDE MD

Original Issue Date

10/22/2018

Effective Date

10/22/2018

Expiration Date

09/30/2020

City

BOUNTIFUL

State

Zip

84010

Ever Disciplined

LastModifiedDate

01/14/2021