GAUTAM DATTA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****47

License Status

ACTIVE

Business

Title

First Name

GAUTAM

Last Name

DATTA

Business Name

GAUTAM DATTA MD

Original Issue Date

07/19/2016

Effective Date

07/18/2023

Expiration Date

07/31/2026

City

GRANITE CITY

State

Zip

62040

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/18/2023