Utah
Division of Occupational and Professional Licensing
KEVEN D BROCKBANK
Physician - Physician & Surgeon
License number
171379-1205
Date granted
06/26/1984
Date expires
03/22/2005
Class
Physician - Physician & Surgeon
Status
Surrendered
Address
SALT LAKE CITY, UT 841232884
utahlicensing.org
ID 29928174
LAST UPDATED 2024-04-30 14:49:44 UTC
LAST UPDATED 2024-04-30 14:49:44 UTC
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