BRENDAN CURRAN STACK, JR. MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****06

License Status

NOT RENEWED

Business

Title

First Name

BRENDAN

Middle

CURRAN

Last Name

STACK, JR.

Business Name

BRENDAN CURRAN STACK, JR. MD

Original Issue Date

02/19/2020

Effective Date

08/05/2020

Expiration Date

07/31/2023

City

SPRINGFIELD

State

Zip

62702

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023