JEREMY SHAUN TALLEY DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125047652

License Status

EXPIRED

Business

First Name

JEREMY

Middle

SHAUN

Last Name

TALLEY

Suffix

Business Name

JEREMY SHAUN TALLEY DO

Original Issue Date

07/01/2004

Effective Date

07/01/2004

Expiration Date

06/30/2007

City

QUINCY

State

Zip

62305

County

ADAMS

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

07/03/2007