VARADENDRA B PANCHAMUKHI MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****09

License Status

NOT RENEWED

Business

First Name

VARADENDRA

Middle

Last Name

PANCHAMUKHI

Suffix

Business Name

VARADENDRA B PANCHAMUKHI MD

Original Issue Date

09/22/1999

Effective Date

06/05/2017

Expiration Date

09/30/2020

City

CARBONDALE

State

Zip

62901

County

JACKSON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021