NEAL THOMAS DECOSTA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****94

License Status

NOT RENEWED

Business

Title

First Name

NEAL

Middle

THOMAS

Last Name

DECOSTA

Business Name

NEAL THOMAS DECOSTA MD

Original Issue Date

10/10/2012

Effective Date

07/24/2017

Expiration Date

09/30/2020

City

BREESE

State

Zip

62230

County

MONROE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III V

Ever Disciplined

LastModifiedDate

01/14/2021