ANTOINE GERGI DACCACHE Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****80

License Status

ACTIVE

Business

First Name

ANTOINE

Middle

GERGI

Last Name

DACCACHE

Business Name

ANTOINE GERGI DACCACHE

Original Issue Date

11/29/2005

Effective Date

04/13/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61637

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/13/2023