PHILLIP BRACKIN (Credential# 562619) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is November 1, 2019. The license expiration date date is October 31, 2020. The license status is ACTIVE.
PHILLIP BRACKIN is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.045037. The credential type is physician/surgeon. The effective date is November 1, 2019. The expiration date is October 31, 2020. The business address is 805 Evans Road, Gwynedd Valley, PA 19437. The current status is active.
| Licensee Name | PHILLIP BRACKIN |
| Credential ID | 562619 |
| Credential Number | 1.045037 |
| Credential Type | Physician/Surgeon |
| Business Address |
805 Evans Road Gwynedd Valley PA 19437 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2007-01-16 |
| Effective Date | 2019-11-01 |
| Expiration Date | 2020-10-31 |
| Refresh Date | 2019-08-06 |
| Street Address | 805 Evans Road |
| City | Gwynedd Valley |
| State | PA |
| Zip Code | 19437 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| George G Brackin | 920 Lorien Drive, Box 279, Gwynedd Valley, PA 19437 | Physician/surgeon | 2019-11-01 ~ 2020-10-31 |
| Annette M Hansen | Po Box 594, Gwynedd Valley, PA 19437 | Registered Nurse | 1992-03-24 ~ 1993-01-31 |
| Ruth G King Md | Po Box 202, Gwynedd Valley, PA 19437-0202 | Controlled Substance Registration for Practitioner | 2019-03-01 ~ 2021-02-28 |
| Bruce E Brooks | Po Box 486, Gwynedd Valley, PA 19437-0486 | Professional Engineer | 2010-02-01 ~ 2011-01-31 |
| City | Gwynedd Valley |
| Zip Code | 19437 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + Gwynedd Valley |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| George G Brackin | 920 Lorien Drive, Box 279, Gwynedd Valley, PA 19437 | Physician/surgeon | 2019-11-01 ~ 2020-10-31 |
| Phillip F Pierce Jr | 3 Fox Den Way, Woodbridge, CT 06525 | Physician/surgeon | 2019-11-01 ~ 2020-10-31 |
| Martin Phillip Kasofsky | Po Box 466, Stanfordville, NY 12581-0466 | Physician/surgeon | 1990-09-28 ~ 1992-02-29 |
| Phillip I Menasche | 19 Truman St, Norwalk, CT 06850-3641 | Physician/surgeon | ~ 1986-04-30 |
| Phillip H Kuo | 2225 E Hampton Street, Tucson, AZ 85719 | Physician/surgeon | 2009-10-01 ~ 2010-09-30 |
| Phillip S Kick | 3640 Main St Ste 103, Springfield, MA 01107-1139 | Physician/surgeon | 2016-04-01 ~ 2017-03-31 |
| Phillip P Luchini | 1481 Chapel St, New Haven, CT 06511 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Phillip E Trowbridge | 10 Upper Heatherwood, Cromwell, CT 06416 | Physician/surgeon | 2006-10-23 ~ 2007-10-31 |
| Jeffrey Phillip Calender | 111 Wendover Rd, Suffield, CT 06078 | Physician/surgeon | 2020-02-01 ~ 2021-01-31 |
| Phillip Andrus Md | 14 Lefurgy Ave, Hastings-on-hudson, NY 10706 | Physician/surgeon | 2019-10-07 ~ 2020-09-30 |
Please comment or provide details below to improve the information on PHILLIP BRACKIN.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).