CALEB OMANDAM PANIAMOGAN DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****26

License Status

NOT RENEWED

Business

First Name

CALEB

Middle

OMANDAM

Last Name

PANIAMOGAN

Suffix

Business Name

CALEB OMANDAM PANIAMOGAN DO

Original Issue Date

06/24/2003

Effective Date

08/15/2017

Expiration Date

09/30/2020

City

ROCK ISLAND

State

Zip

61201

County

ROCK ISLAND

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021