JEREMY SHANE STEVENS MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****85

License Status

ACTIVE

Business

Title

First Name

JEREMY

Middle

SHANE

Last Name

STEVENS

Business Name

JEREMY SHANE STEVENS MD

Original Issue Date

09/10/2004

Effective Date

06/17/2023

Expiration Date

07/31/2026

City

MATTOON

State

Zip

61938

County

COLES

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/17/2023