DEEPA MOKSHAGUNDAM MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****54

License Status

ACTIVE

Business

Title

First Name

DEEPA

Last Name

MOKSHAGUNDAM

Business Name

DEEPA MOKSHAGUNDAM MD

Original Issue Date

08/28/2020

Effective Date

06/28/2023

Expiration Date

07/31/2026

City

SHILOH

State

Zip

62269

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/28/2023