RAZ D PENMATCHA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****80

License Status

NOT RENEWED

Business

First Name

RAZ

Middle

Last Name

PENMATCHA

Suffix

Business Name

RAZ D PENMATCHA MD

Original Issue Date

10/03/2002

Effective Date

04/24/2014

Expiration Date

07/31/2017

City

ROCK ISLAND

State

Zip

61201

County

ROCK ISLAND

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017