GAUTAM GUPTA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****95

License Status

NOT RENEWED

Business

First Name

GAUTAM

Last Name

GUPTA

Suffix

Business Name

GAUTAM GUPTA MD

Original Issue Date

01/30/2002

Effective Date

04/25/2011

Expiration Date

07/31/2014

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014