SURASAK PHUPHANICH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036058266

License Status

NOT RENEWED

Business

First Name

SURASAK

Last Name

PHUPHANICH

Suffix

Business Name

SURASAK PHUPHANICH MD

Original Issue Date

12/19/1978

Effective Date

12/19/1978

Expiration Date

07/31/1984

City

SAN BRUNO

State

Zip

94066

County

CALIFORNIA

Ever Disciplined

LastModifiedDate

12/07/2006