GINA LYNN DIETRICH DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****79

License Status

ACTIVE

Business

First Name

GINA

Middle

LYNN

Last Name

DIETRICH

Suffix

Business Name

GINA LYNN DIETRICH DO

Original Issue Date

03/11/2002

Effective Date

06/03/2023

Expiration Date

07/31/2026

City

QUINCY

State

Zip

62301

County

ADAMS

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/03/2023