OMAR U MUDALLAL MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****91

License Status

ACTIVE

Business

Title

First Name

OMAR

Middle

Last Name

MUDALLAL

Business Name

OMAR U MUDALLAL MD

Original Issue Date

06/17/2019

Effective Date

04/06/2023

Expiration Date

07/31/2026

City

WILDWOOD

State

Zip

63038

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/06/2023