JACQUELYN BROOKE STEVENS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****43

License Status

NOT RENEWED

Business

First Name

JACQUELYN BROOKE

Last Name

STEVENS

Suffix

Business Name

JACQUELYN BROOKE STEVENS MD

Original Issue Date

11/05/1996

Effective Date

11/05/1996

Expiration Date

07/31/2002

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/21/2017