PRAVESH PRABHU DEOTALE MD - Medical Doctor License in Missouri | # 125059332

PRAVESH PRABHU DEOTALE MD

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125059332

License Status

CANCELLED

Business

N

Title

MD

First Name

PRAVESH

Middle

PRABHU

Last Name

DEOTALE

Business Name

PRAVESH PRABHU DEOTALE MD

Original Issue Date

06/26/2011

Effective Date

06/26/2011

Expiration Date

06/25/2014

State

MO

Specialty/Qualifier

Psychiatry

Ever Disciplined

N

LastModifiedDate

03/24/2014