BENJAMIN MANGAOA SY MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****74

License Status

NOT RENEWED

Business

First Name

BENJAMIN MANGAOA

Last Name

Suffix

Business Name

BENJAMIN MANGAOA SY MD

Original Issue Date

01/01/1997

Expiration Date

07/31/1990

City

SAVANNA

State

Zip

61074

County

CARROLL

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006