BRIAN K BEVACQUA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****60

License Status

NOT RENEWED

Business

First Name

BRIAN

Middle

Last Name

BEVACQUA

Suffix

Business Name

BRIAN K BEVACQUA MD

Original Issue Date

01/13/1986

Effective Date

01/13/1986

Expiration Date

07/31/1987

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006