JOHN STONE SHALLAT MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****96

License Status

ACTIVE

Business

First Name

JOHN

Middle

STONE

Last Name

SHALLAT

Suffix

Business Name

JOHN STONE SHALLAT MD

Original Issue Date

06/29/1999

Effective Date

06/26/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61614

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/26/2023