STONEWALL MCCUISTON JR MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****73

License Status

NOT RENEWED

Business

First Name

STONEWALL

Last Name

MCCUISTON JR

Suffix

Business Name

STONEWALL MCCUISTON JR MD

Original Issue Date

11/04/1993

Effective Date

04/17/2008

Expiration Date

07/31/2011

City

KANKAKEE

State

Zip

60901

County

KANKAKEE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020