RYAN R PINE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****74

License Status

ACTIVE

Business

Title

First Name

RYAN

Middle

Last Name

PINE

Business Name

RYAN R PINE MD

Original Issue Date

09/12/2012

Effective Date

06/28/2023

Expiration Date

07/31/2026

City

MATTOON

State

Zip

61938

County

COLES

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/05/2025