PRAVESH PRABHU DEOTALE MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125059332

License Status

CANCELLED

Business

Title

First Name

PRAVESH

Middle

PRABHU

Last Name

DEOTALE

Business Name

PRAVESH PRABHU DEOTALE MD

Original Issue Date

06/26/2011

Effective Date

06/26/2011

Expiration Date

06/25/2014

City

SAINT LOUIS

State

Zip

63132

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

03/24/2014