PANIDA PIBOOLNURAK Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125036700

License Status

CANCELLED

Business

First Name

PANIDA

Last Name

PIBOOLNURAK

Business Name

PANIDA PIBOOLNURAK

Original Issue Date

06/13/1997

Effective Date

06/13/1997

Expiration Date

06/25/2000

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

Neurology

Ever Disciplined

LastModifiedDate

09/22/2006