STEPHAN WES SHANE DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****40

License Status

ACTIVE

Business

First Name

STEPHAN

Middle

WES

Last Name

SHANE

Suffix

Business Name

STEPHAN WES SHANE DO

Original Issue Date

08/06/1998

Effective Date

06/04/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61615

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/04/2023