SUE ELLEN CLARK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036093117

License Status

NOT RENEWED

Business

First Name

SUE ELLEN

Last Name

CLARK

Suffix

Business Name

SUE ELLEN CLARK MD

Original Issue Date

06/08/1996

Effective Date

10/01/2020

Expiration Date

07/31/2023

City

PEORIA

State

Zip

61637

County

PEORIA

Ever Disciplined

LastModifiedDate

11/30/2023