MANJU BENGALURU JAYANNA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****25

License Status

NOT RENEWED

Business

Title

First Name

MANJU

Last Name

BENGALURU JAYANNA

Business Name

MANJU BENGALURU JAYANNA MD

Original Issue Date

06/02/2014

Effective Date

06/02/2014

Expiration Date

07/31/2017

City

NORMAL

State

Zip

61761

County

MCLEAN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017