URAIWAN T HOMPLUEM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****18

License Status

NOT RENEWED

Business

First Name

URAIWAN

Middle

Last Name

HOMPLUEM

Suffix

Business Name

URAIWAN T HOMPLUEM MD

Original Issue Date

07/08/2002

Effective Date

04/17/2017

Expiration Date

09/30/2020

City

GLEN CARBON

State

Zip

62034

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021