JAVIER ANDRES TELLAGORRY MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****57

License Status

NOT RENEWED

Business

Title

First Name

JAVIER

Middle

ANDRES

Last Name

TELLAGORRY

Business Name

JAVIER ANDRES TELLAGORRY MD

Original Issue Date

07/08/2016

Effective Date

09/09/2020

Expiration Date

07/31/2023

City

MARION

State

Zip

62959

County

WILLIAMSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

11/30/2023