STEPHAN WES SHANE DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036098583

License Status

ACTIVE

Business

First Name

STEPHAN

Middle

WES

Last Name

SHANE

Suffix

Business Name

STEPHAN WES SHANE DO

Original Issue Date

08/04/1998

Effective Date

06/04/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61615

County

PEORIA

Ever Disciplined

LastModifiedDate

06/04/2023