TINA M GINGRICH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****07

License Status

NOT RENEWED

Business

First Name

TINA M

Last Name

GINGRICH

Suffix

Business Name

TINA M GINGRICH MD

Original Issue Date

11/05/1993

Effective Date

06/21/2017

Expiration Date

09/30/2020

City

MARYVILLE

State

Zip

62062

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021