STEPHAN WES SHANE DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125034476

License Status

EXPIRED

Business

First Name

STEPHAN

Middle

WES

Last Name

SHANE

Suffix

Business Name

STEPHAN WES SHANE DO

Original Issue Date

05/20/1996

Effective Date

05/20/1996

Expiration Date

06/30/1999

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006