KEITH ALAN SHAW 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

First Name

KEITH ALAN

Last Name

SHAW

Suffix

Business Name

KEITH ALAN SHAW MD

Original Issue Date

01/01/1997

Effective Date

06/16/2020

Expiration Date

07/31/2023

City

GALENA

State

Zip

61036

County

JO DAVIESS

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023