AUSTIN BANNING DEROSA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****76

License Status

NOT RENEWED

Business

Title

First Name

AUSTIN

Middle

BANNING

Last Name

DEROSA

Business Name

AUSTIN BANNING DEROSA MD

Original Issue Date

03/11/2016

Effective Date

07/19/2017

Expiration Date

09/30/2020

City

QUINCY

State

Zip

62301

County

ADAMS

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021