THAVISAK PHURIPHAN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036054632

License Status

NOT RENEWED

Business

First Name

THAVISAK

Last Name

PHURIPHAN

Suffix

Business Name

THAVISAK PHURIPHAN MD

Original Issue Date

05/13/1977

Effective Date

05/13/1977

City

BRONX

State

Zip

10475

County

NEW YORK

Ever Disciplined

LastModifiedDate

09/20/2006