SOPA L VONGSVIVUT MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036048153

License Status

NOT RENEWED

Business

First Name

SOPA L

Last Name

VONGSVIVUT

Suffix

Business Name

SOPA L VONGSVIVUT MD

Original Issue Date

08/23/1973

Effective Date

08/23/1973

Expiration Date

07/31/2002

City

GODFREY

State

Zip

62035

Ever Disciplined

LastModifiedDate

02/06/2007