PRASHANT B SHAH MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****66

License Status

NOT RENEWED

Business

First Name

PRASHANT B

Last Name

SHAH

Suffix

Business Name

PRASHANT B SHAH MD

Original Issue Date

09/09/1982

Effective Date

05/11/2017

Expiration Date

09/30/2020

City

CENTRALIA

State

Zip

62801

County

MARION

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/14/2021