JAY PRAVIN SHAH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****63

License Status

NOT RENEWED

Business

Title

First Name

JAY

Middle

PRAVIN

Last Name

SHAH

Business Name

JAY PRAVIN SHAH MD

Original Issue Date

01/08/2015

Effective Date

01/08/2015

Expiration Date

07/31/2017

City

ROSCOE

State

Zip

61073

County

WINNEBAGO

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017