PRAVESH PRABHU DEOTALE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****86

License Status

NOT RENEWED

Business

Title

First Name

PRAVESH

Middle

PRABHU

Last Name

DEOTALE

Business Name

PRAVESH PRABHU DEOTALE MD

Original Issue Date

06/19/2014

Effective Date

06/19/2014

Expiration Date

07/31/2017

City

SAINT LOUIS

State

Zip

63127

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020