SURYA N GUPTA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****54

License Status

NOT RENEWED

Business

Title

First Name

SURYA

Middle

Last Name

GUPTA

Business Name

SURYA N GUPTA MD

Original Issue Date

03/28/2019

Effective Date

09/03/2020

Expiration Date

07/31/2023

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023