TEERATH PETER TANPITUKPONGSE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****49

License Status

NOT RENEWED

Business

Title

First Name

TEERATH

Middle

PETER

Last Name

TANPITUKPONGSE

Business Name

TEERATH PETER TANPITUKPONGSE MD

Original Issue Date

02/19/2015

Effective Date

02/19/2015

Expiration Date

07/31/2017

City

SPRINGFIELD

State

Zip

62781

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017