TRAVIS GRAHAM PETRICEK MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****60

License Status

ACTIVE

Business

Title

First Name

TRAVIS

Middle

GRAHAM

Last Name

PETRICEK

Business Name

TRAVIS GRAHAM PETRICEK MD

Original Issue Date

04/03/2021

Effective Date

06/20/2023

Expiration Date

07/31/2026

City

OLNEY

State

Zip

62450

County

RICHLAND

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/20/2023