MOJABENG PHOOFOLO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****23

License Status

NOT RENEWED

Business

Title

First Name

MOJABENG

Last Name

PHOOFOLO

Business Name

MOJABENG PHOOFOLO MD

Original Issue Date

09/16/2011

Effective Date

09/16/2011

Expiration Date

07/31/2014

City

SILVIS

State

Zip

61282

County

ROCK ISLAND

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014