JYOTHI D GUDLA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****11

License Status

NOT RENEWED

Business

First Name

JYOTHI

Middle

Last Name

GUDLA

Suffix

Business Name

JYOTHI D GUDLA MD

Original Issue Date

11/06/2001

Effective Date

09/25/2018

Expiration Date

09/30/2020

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021