TITO A CHAMPENA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****73

License Status

NOT RENEWED

Business

First Name

TITO A

Last Name

CHAMPENA

Suffix

Business Name

TITO A CHAMPENA MD

Original Issue Date

01/01/1997

Effective Date

04/12/2017

Expiration Date

09/30/2020

City

EFFINGHAM

State

Zip

62401

County

EFFINGHAM

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021