TIMOTHY JOSEPH MANDA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****94

License Status

NOT RENEWED

Business

First Name

TIMOTHY

Middle

JOSEPH

Last Name

MANDA

Suffix

Business Name

TIMOTHY JOSEPH MANDA MD

Original Issue Date

10/18/2007

Effective Date

04/21/2011

Expiration Date

07/31/2014

City

BELLEVILLE

State

Zip

62226

County

SAINT CLAIR

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014