JACQUELYN L CLARK - Medical Doctor License in Illinois | # 125021276

JACQUELYN L CLARK

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125021276

License Status

EXPIRED

Business

N

First Name

JACQUELYN

Middle

L

Last Name

CLARK

Business Name

JACQUELYN L CLARK

Original Issue Date

06/11/1987

Effective Date

06/11/1987

Expiration Date

07/01/1990

State

IL

Specialty/Qualifier

Family Medicine

Ever Disciplined

N

LastModifiedDate

09/22/2006