PHILLIP L STALL MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125067407

License Status

EXPIRED

Business

Title

First Name

PHILLIP

Middle

Last Name

STALL

Business Name

PHILLIP L STALL MD

Original Issue Date

07/01/2015

Effective Date

07/01/2015

Expiration Date

06/30/2018

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Psychiatry

Ever Disciplined

LastModifiedDate

10/25/2018