PURUSHOTHAM RAO BHAGAVATH Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****71

License Status

NOT RENEWED

Business

First Name

PURUSHOTHAM RAO

Last Name

BHAGAVATH

Business Name

PURUSHOTHAM RAO BHAGAVATH

Original Issue Date

11/19/1993

Effective Date

11/19/1993

Expiration Date

07/31/1996

City

MATTOON

State

Zip

61938

County

COLES

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006