CHALERMLARP MONGKOLSMAI MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****04

License Status

NOT RENEWED

Business

First Name

CHALERMLARP

Last Name

MONGKOLSMAI

Suffix

Business Name

CHALERMLARP MONGKOLSMAI MD

Original Issue Date

01/01/1997

Effective Date

04/21/2014

Expiration Date

07/31/2017

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017