RAZ D PENMATCHA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****90

License Status

NOT RENEWED

Business

First Name

RAZ

Middle

Last Name

PENMATCHA

Suffix

Business Name

RAZ D PENMATCHA MD

Original Issue Date

05/25/2004

Effective Date

06/15/2011

Expiration Date

07/31/2014

City

PRINCETON

State

Zip

61356

County

BUREAU

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/12/2017