VICENTE MAURICIO GONZAGA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****23

License Status

NOT RENEWED

Business

Title

First Name

VICENTE

Middle

MAURICIO

Last Name

GONZAGA

Business Name

VICENTE MAURICIO GONZAGA MD

Original Issue Date

05/17/2011

Effective Date

10/11/2016

Expiration Date

07/31/2017

City

SOUTH BEND

State

Zip

46615

County

INDIANA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017