MARIO BAUTISTA SY MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****99

License Status

ACTIVE

Business

First Name

MARIO

Middle

BAUTISTA

Last Name

Suffix

Business Name

MARIO BAUTISTA SY MD

Original Issue Date

04/11/2003

Effective Date

10/05/2023

Expiration Date

07/31/2026

City

BETTENDORF

State

Zip

52722

County

IOWA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/05/2023