RUSSELL H CLARK JR MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036039610

License Status

NOT RENEWED

Business

First Name

RUSSELL H

Last Name

CLARK JR

Suffix

Business Name

RUSSELL H CLARK JR MD

Original Issue Date

05/25/1965

Effective Date

07/28/2014

Expiration Date

07/31/2017

City

LAKE FOREST

State

Zip

60045

County

LAKE

Ever Disciplined

LastModifiedDate

11/01/2017