GORANTLA GOVINDAIAH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****34

License Status

NOT RENEWED

Business

First Name

GORANTLA

Last Name

GOVINDAIAH

Suffix

Business Name

GORANTLA GOVINDAIAH MD

Original Issue Date

01/01/1997

Effective Date

07/24/2017

Expiration Date

09/30/2020

City

MOLINE

State

Zip

61265

County

ROCK ISLAND

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021