BANPOTE POOSUTHASEE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****28

License Status

NOT RENEWED

Business

First Name

BANPOTE

Last Name

POOSUTHASEE

Suffix

Business Name

BANPOTE POOSUTHASEE MD

Original Issue Date

07/29/1981

Effective Date

07/29/1981

Expiration Date

09/01/1982

City

WOOD RIVER

State

Zip

62095

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006