MARK A BULLOCK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036044262

License Status

NOT RENEWED

Business

First Name

MARK A

Last Name

BULLOCK

Suffix

Business Name

MARK A BULLOCK MD

Original Issue Date

07/01/1971

Effective Date

07/31/2006

Expiration Date

07/31/2008

City

PEORIA

State

Zip

61614

County

PEORIA

Ever Disciplined

LastModifiedDate

11/06/2008