STEPHEN PATRICK SUPPLE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****55

License Status

ACTIVE

Business

Title

First Name

STEPHEN

Middle

PATRICK

Last Name

SUPPLE

Business Name

STEPHEN PATRICK SUPPLE MD

Original Issue Date

03/23/2023

Effective Date

05/04/2023

Expiration Date

07/31/2026

City

EAST PEORIA

State

Zip

61611

County

TAZEWELL

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/04/2023