SOPA L VONGSVIVUT MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****43

License Status

NOT RENEWED

Business

First Name

SOPA L

Last Name

VONGSVIVUT

Suffix

Business Name

SOPA L VONGSVIVUT MD

Original Issue Date

07/22/1981

Effective Date

07/22/1981

Expiration Date

07/31/1984

City

ALTON

State

Zip

62002

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006