DAVID WILLIAM MACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036045619

License Status

NOT RENEWED

Business

First Name

DAVID

Middle

WILLIAM

Last Name

MACK

Suffix

Business Name

DAVID WILLIAM MACK MD

Original Issue Date

04/13/1972

Effective Date

04/25/2014

Expiration Date

07/31/2017

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Ever Disciplined

LastModifiedDate

11/01/2017