RICHARD LARK DICICCO MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036111864

License Status

INACTIVE

Business

First Name

RICHARD

Middle

LARK

Last Name

DICICCO

Suffix

Business Name

RICHARD LARK DICICCO MD

Original Issue Date

07/15/2004

Effective Date

07/15/2004

Expiration Date

07/31/2005

City

TAMPA

State

Zip

33606

County

FLORIDA

Ever Disciplined

LastModifiedDate

10/09/2006