DEREK O'NEIL STOUT DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036107399

License Status

ACTIVE

Business

First Name

DEREK

Middle

O'NEIL

Last Name

STOUT

Suffix

Business Name

DEREK O'NEIL STOUT DO

Original Issue Date

07/08/2002

Effective Date

04/13/2023

Expiration Date

07/31/2026

City

MATTOON

State

Zip

61938

County

COLES

Ever Disciplined

LastModifiedDate

04/13/2023