DEREK E CLEVIDENCE MD - Medical Doctor License in Wisconsin | # 036100512

DEREK E CLEVIDENCE MD

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036100512

License Status

INACTIVE

Business

N

First Name

DEREK

Middle

E

Last Name

CLEVIDENCE

Suffix

MD

Business Name

DEREK E CLEVIDENCE MD

Original Issue Date

07/02/1999

Effective Date

07/02/1999

Expiration Date

07/31/2002

State

WI

Ever Disciplined

N

LastModifiedDate

10/09/2006