AMANDA VASTAG MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****00

License Status

NOT RENEWED

Business

Title

First Name

AMANDA

Last Name

VASTAG

Business Name

AMANDA VASTAG MD

Original Issue Date

03/02/2016

Effective Date

06/12/2017

Expiration Date

09/30/2020

City

PEORIA

State

Zip

61602

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021