ALEXIS C BOUTENEFF MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****54

License Status

NOT RENEWED

Business

Title

First Name

ALEXIS

Middle

Last Name

BOUTENEFF

Business Name

ALEXIS C BOUTENEFF MD

Original Issue Date

08/07/2018

Effective Date

08/07/2018

Expiration Date

09/30/2020

City

PEORIA

State

Zip

61637

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021