LACEY DIVELY MOY MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****57

License Status

ACTIVE

Business

Title

First Name

LACEY

Middle

DIVELY

Last Name

MOY

Business Name

LACEY DIVELY MOY MD

Original Issue Date

11/18/2011

Effective Date

04/08/2023

Expiration Date

07/31/2026

City

SPRINGFIELD

State

Zip

62707

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/08/2023