STANLEY KOGAN 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

First Name

STANLEY

Last Name

KOGAN

Business Name

STANLEY KOGAN

Original Issue Date

11/12/2020

Effective Date

11/12/2020

Expiration Date

07/31/2023

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023