GEORGI NICOLE BROCKWAY MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****33

License Status

ACTIVE

Business

Title

First Name

GEORGI

Middle

NICOLE

Last Name

BROCKWAY

Business Name

GEORGI NICOLE BROCKWAY MD

Original Issue Date

10/30/2023

Effective Date

10/30/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61603

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/06/2023