STACIE D MCCLANE 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

STACIE

Middle

Last Name

MCCLANE

Suffix

Business Name

STACIE D MCCLANE MD

Original Issue Date

03/25/2002

Effective Date

03/25/2002

Expiration Date

07/31/2005

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020