THANOM TEMIYASATHIT MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****62

License Status

NOT RENEWED

Business

First Name

THANOM

Last Name

TEMIYASATHIT

Suffix

Business Name

THANOM TEMIYASATHIT MD

Original Issue Date

01/01/1997

Effective Date

04/24/2017

Expiration Date

09/30/2020

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021