ANDREW MARK GAILLARDETZ MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****31

License Status

ACTIVE

Business

Title

First Name

ANDREW

Middle

MARK

Last Name

GAILLARDETZ

Business Name

ANDREW MARK GAILLARDETZ MD

Original Issue Date

03/02/2021

Effective Date

06/30/2023

Expiration Date

07/31/2026

City

SHILOH

State

Zip

62269

County

SAINT CLAIR

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/30/2023