License holder summary

GLENN MITCHELL FORMAN is a Medical Physician And Surgeon licensed to practice in Pennsylvania. The address on file for GLENN MITCHELL FORMAN is Bethlehem PA 18018. This medical practitioner license is not current. The license was granted 06/16/1999 and expired on 12/31/2006.

Department of State

Board of Medicine

GLENN MITCHELL FORMAN
Medical Physician And Surgeon
License number
MD068393L
Date granted
06/16/1999
Date expires
12/31/2006
Class
Medical Physician And Surgeon
Status
Expired
Address
Bethlehem PA 18018
medicinepa.com
ID 37610575
LAST UPDATED 2024-02-19 08:36:36 UTC

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