R GANGADHARA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036051635

License Status

NOT RENEWED

Business

First Name

Last Name

GANGADHARA

Suffix

Business Name

R GANGADHARA MD

Original Issue Date

08/15/1975

Effective Date

08/15/1975

City

FORT WAYNE

State

Zip

46805

County

INDIANA

Ever Disciplined

LastModifiedDate

09/20/2006