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DHMH : cdssearch: M25774

CDSPERMIT

M25774

APPLICANT_NAME

A BERNARD PLEET

APPLICANT_STATUS

NON RENEWED

CLASSIFICATION

PRACTITIONER

ADRESS

BAYSTATE MEDICAL CTR

CITY

SPRINGFIELD

COUNTY

 

ZIP

1199

STATE

MA

ADDRESS2

759 CHESTNUT ST

PROFESSION

MD

LICENSE_ISSUEDDATE

6/1/2000 12:00 AM

LICENSE_EXPDATE

6/30/2002 12:00 AM

CURR_CERTIFICATION

Y

Attachments

Created at 11/21/2013 11:55 AM by System Account
Last modified at 11/21/2013 11:55 AM by System Account