AUSTIN BANNING DEROSA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036139996

License Status

NOT RENEWED

Business

Title

First Name

AUSTIN

Middle

BANNING

Last Name

DEROSA

Business Name

AUSTIN BANNING DEROSA MD

Original Issue Date

03/11/2016

Effective Date

07/19/2017

Expiration Date

09/30/2020

City

QUINCY

State

Zip

62301

County

ADAMS

Ever Disciplined

LastModifiedDate

01/14/2021