THOMAS STANLEY STEVENS MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****84

License Status

NOT RENEWED

Business

First Name

THOMAS

Middle

STANLEY

Last Name

STEVENS

Suffix

Business Name

THOMAS STANLEY STEVENS MD

Original Issue Date

08/06/1996

Effective Date

05/20/2014

Expiration Date

07/31/2017

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

11/01/2017