RUSTAN J WIERSMA MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036054021

License Status

INACTIVE

Business

First Name

RUSTAN J

Last Name

WIERSMA

Suffix

Business Name

RUSTAN J WIERSMA MD

Original Issue Date

12/14/1976

Effective Date

12/14/1976

Expiration Date

07/31/2005

City

LACROSSE

State

Zip

54601

County

WISCONSIN

Ever Disciplined

LastModifiedDate

10/09/2006