UDOM SANTATIVONGCHAI MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****42

License Status

NOT RENEWED

Business

First Name

UDOM

Last Name

SANTATIVONGCHAI

Suffix

Business Name

UDOM SANTATIVONGCHAI MD

Original Issue Date

01/01/1997

Expiration Date

01/01/1997

City

HOPEDALE

State

Zip

61747

County

TAZEWELL

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006