BRETT IAN SCHUPACK DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****72

License Status

ACTIVE

Business

Title

First Name

BRETT

Middle

IAN

Last Name

SCHUPACK

Business Name

BRETT IAN SCHUPACK DO

Original Issue Date

03/17/2023

Effective Date

07/09/2023

Expiration Date

07/31/2026

City

BRIDGETON

State

Zip

63044

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/09/2023