GAUTAM DATTA MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036141269

License Status

ACTIVE

Business

Title

First Name

GAUTAM

Last Name

DATTA

Business Name

GAUTAM DATTA MD

Original Issue Date

07/19/2016

Effective Date

07/18/2023

Expiration Date

07/31/2026

City

SAINT LOUIS

State

Zip

63124

County

MISSOURI

Ever Disciplined

LastModifiedDate

07/18/2023