SUPRIYA GUPTA MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125065488

License Status

CANCELLED

Business

Title

First Name

SUPRIYA

Last Name

GUPTA

Business Name

SUPRIYA GUPTA MD

Original Issue Date

06/26/2014

Effective Date

06/26/2014

Expiration Date

06/25/2017

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/13/2017