SUPHAVIT MUTTAMARA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036049598

License Status

NOT RENEWED

Business

First Name

SUPHAVIT

Last Name

MUTTAMARA

Suffix

Business Name

SUPHAVIT MUTTAMARA MD

Original Issue Date

08/28/1974

Effective Date

08/28/1974

Expiration Date

07/31/1984

City

MOUNT ARLINGTON

State

Zip

07856

County

NEW JERSEY

Ever Disciplined

LastModifiedDate

09/20/2006