SAMUEL S W PARK MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036063669

License Status

ACTIVE

Business

First Name

SAMUEL S W

Last Name

PARK

Suffix

Business Name

SAMUEL S W PARK MD

Original Issue Date

12/16/1981

Effective Date

04/08/2023

Expiration Date

07/31/2026

City

ROSCOE

State

Zip

61073

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

04/08/2023