SRIDEVI V PANCHAMUKHI MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****98

License Status

NOT RENEWED

Business

First Name

SRIDEVI

Middle

Last Name

PANCHAMUKHI

Suffix

Business Name

SRIDEVI V PANCHAMUKHI MD

Original Issue Date

08/04/2005

Effective Date

08/04/2005

Expiration Date

07/31/2008

City

HERRIN

State

Zip

62948

County

WILLIAMSON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020