MELODY VAN BOERUM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036155447

License Status

NOT RENEWED

Business

Title

First Name

MELODY

Last Name

VAN BOERUM

Business Name

MELODY VAN BOERUM MD

Original Issue Date

01/29/2021

Effective Date

01/29/2021

Expiration Date

07/31/2023

City

SALT LAKE CITY

State

Zip

84106

Ever Disciplined

LastModifiedDate

11/30/2023