STONEWALL MCCUISTON JR MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****72

License Status

ACTIVE

Business

First Name

STONEWALL

Last Name

MCCUISTON JR

Suffix

Business Name

STONEWALL MCCUISTON JR MD

Original Issue Date

06/10/1987

Effective Date

05/01/2023

Expiration Date

07/31/2026

City

KANKAKEE

State

Zip

60901

County

KANKAKEE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/01/2023