TERMKIAT KANCHANAPOOM MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****32

License Status

NOT RENEWED

Business

First Name

TERMKIAT

Last Name

KANCHANAPOOM

Suffix

Business Name

TERMKIAT KANCHANAPOOM MD

Original Issue Date

06/26/2000

Effective Date

06/26/2000

Expiration Date

07/31/2002

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

10/09/2006