BRIAN DAVID TALLERICO DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****15

License Status

NOT RENEWED

Business

Title

First Name

BRIAN DAVID

Last Name

TALLERICO

Business Name

BRIAN DAVID TALLERICO DO

Original Issue Date

09/01/2017

Effective Date

09/01/2017

Expiration Date

09/30/2020

City

QUINCY

State

Zip

62301

County

ADAMS

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021