CODY MICHAEL-TY DECK DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125077949

License Status

CANCELLED

Business

Title

First Name

CODY

Middle

MICHAEL-TY

Last Name

DECK

Business Name

CODY MICHAEL-TY DECK DO

Original Issue Date

07/01/2021

Effective Date

07/01/2021

Expiration Date

06/30/2024

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

06/01/2021