WORAWUTE SUPAONGPRAPA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****03

License Status

ACTIVE

Business

Title

First Name

WORAWUTE

Last Name

SUPAONGPRAPA

Business Name

WORAWUTE SUPAONGPRAPA MD

Original Issue Date

04/29/2022

Effective Date

06/23/2023

Expiration Date

07/31/2026

City

ROCKFORD

State

Zip

61104

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/23/2023