AJAY B PONKSHE Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****91

License Status

CANCELLED

Business

First Name

AJAY B

Last Name

PONKSHE

Business Name

AJAY B PONKSHE

Original Issue Date

09/17/1999

Effective Date

09/17/1999

Expiration Date

07/31/2005

City

CARBONDALE

State

Zip

62901

County

JACKSON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006