CHARLES R CLARK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036049784

License Status

NOT RENEWED

Business

First Name

CHARLES R

Last Name

CLARK

Suffix

Business Name

CHARLES R CLARK MD

Original Issue Date

08/28/1974

Effective Date

08/28/1974

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Ever Disciplined

LastModifiedDate

09/20/2006