DEREK G KENNEASTER MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****61

License Status

ACTIVE

Business

First Name

DEREK G

Last Name

KENNEASTER

Suffix

Business Name

DEREK G KENNEASTER MD

Original Issue Date

08/01/1996

Effective Date

07/06/2023

Expiration Date

07/31/2026

City

HERRIN

State

Zip

62948

County

WILLIAMSON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/06/2023