BRANDON V MACK MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****39

License Status

ACTIVE

Business

First Name

BRANDON

Middle

Last Name

MACK

Suffix

Business Name

BRANDON V MACK MD

Original Issue Date

10/06/2025

Effective Date

10/06/2025

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/06/2025