DAVID WAYNE KELLEY DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****22

License Status

NOT RENEWED

Business

Title

First Name

DAVID

Middle

WAYNE

Last Name

KELLEY

Business Name

DAVID WAYNE KELLEY DO

Original Issue Date

02/22/2012

Effective Date

02/22/2012

Expiration Date

07/31/2014

City

PEORIA

State

Zip

61615

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/12/2017