DOUGLASS TAKASHI DOMOTO MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036057380

License Status

INACTIVE

Business

First Name

DOUGLASS TAKASHI

Last Name

DOMOTO

Suffix

Business Name

DOUGLASS TAKASHI DOMOTO MD

Original Issue Date

08/21/1978

Effective Date

08/21/1978

Expiration Date

07/31/2005

City

SAINT LOUIS

State

Zip

63103

County

MISSOURI

Ever Disciplined

LastModifiedDate

10/09/2006