TAVEEPONG TERAYANONT MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****10

License Status

ACTIVE

Business

First Name

TAVEEPONG

Last Name

TERAYANONT

Suffix

Business Name

TAVEEPONG TERAYANONT MD

Original Issue Date

06/08/1989

Effective Date

06/22/2023

Expiration Date

07/31/2026

City

ROSCOE

State

Zip

61073

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/22/2023