BOONLUA LUCKTONG MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036048764

License Status

NOT RENEWED

Business

First Name

BOONLUA

Last Name

LUCKTONG

Suffix

Business Name

BOONLUA LUCKTONG MD

Original Issue Date

02/05/1974

Effective Date

02/05/1974

Expiration Date

07/31/1984

City

NEWPORT

State

Zip

37821

County

TENNESSEE

Ever Disciplined

LastModifiedDate

09/20/2006