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Prakash Goutham
Prakash goutham
Suryanarayana
Medical doctor
Orange Park, United States
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Florida Health Care Practitioner Data Portal
Full name
Prakash Goutham Suryanarayana
Job Title
Medical Doctor
Location
Orange Park, FL, USA
LIC ID
157083
Current License Expiration Date
31/01/2026
Original Date
29/09/2021
Professional Rank Code
ME
Effective Date
29/09/2021
Board Action Indicator
N
License Status Description
CLEAR
License Active Status Description
ACTIVE
Country Description
CLAY
Practice Location Address Line 1
655 W 8th Street
Practice Location Address City
JACKSONVILLE
Practice Location Address State
FL
Practice Location Address Zipcode
32209
Prescribing Indicator
N
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