License Verification

Printer Friendly Version

DEVINA KOMALAWATI SIREGAR MCCRAY

License Number: ME107029

Data As Of 12/2/2024

Profession
Medical Doctor
License
ME107029
License Status
CLEAR/Active
License Expiration Date
1/31/2026
License Original Issue Date
04/28/2010
Address of Record
661 E. Altamonte Drive
Suite 231
ALTAMONTE SPRINGS, FL 32701
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
380 Celebration Pl 2nd floor
CELEBRATION, FL 34747
Address
2501 N Orange Avenue Suite 201
ORLANDO, FL 32804
Address
960 Rinehart Rd Suite 104
LAKE MARY, FL 32746
Name Relationship Profession License Effective Date

Click on the License Number to view License Details for that Practitioner

Name Relationship Profession License Effective Date
VAN DYKE, TRAVIS BOYD Subordinate Medical Doctor 92680 2/1/2018
WIESE, JON DICK MD Subordinate Medical Doctor 54060 2/1/2018

Click on the License Number to view License Details for that Practitioner

Name Relationship Profession License Effective Date

Click on the License Number to view License Details for that Practitioner



No Continuing Education Hours Received from Approved Providers As Of 12/2/2024



* To find out more about Approved Providers, or ask a provider why the course you took is not yet listed, please visit our Continuing Education Providers page.


** Personal Development is limited to no more than 3 hours per renewal cycle. Any personal development hours in excess of this 3 hour maximum cannot be used for renewal and have been subtracted from the total available for renewal.


Please do not fax proof of Continuing Education hours to the Board Office until you have received your renewal notice in the mail.


For instructions on how to request a license certification of your Florida license to be sent to another state from the Florida Department of Health, please visit the License Certifications web page.