FOURUTAN TIM SHAFIEI MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****29

License Status

ACTIVE

Business

Title

First Name

FOURUTAN

Middle

TIM

Last Name

SHAFIEI

Business Name

FOURUTAN TIM SHAFIEI MD

Original Issue Date

02/18/2021

Effective Date

07/04/2023

Expiration Date

07/31/2026

City

SPRINGFIELD

State

Zip

62711

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/04/2023