GAUTAM VANGIPURAM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036150349

License Status

NOT RENEWED

Business

Title

First Name

GAUTAM

Last Name

VANGIPURAM

Business Name

GAUTAM VANGIPURAM MD

Original Issue Date

07/27/2019

Effective Date

05/29/2020

Expiration Date

07/31/2023

City

MOUNT VERNON

State

Zip

62864

County

JEFFERSON

Ever Disciplined

LastModifiedDate

11/30/2023