DEVAUGHN KENNE PEACE LL Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****36

License Status

ACTIVE

Business

First Name

DEVAUGHN

Middle

KENNE

Last Name

PEACE LL

Business Name

DEVAUGHN KENNE PEACE LL

Original Issue Date

07/07/2020

Effective Date

07/21/2023

Expiration Date

07/31/2026

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/21/2023