TED ROBERT CLARK MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036122966

License Status

ACTIVE

Business

First Name

TED

Middle

ROBERT

Last Name

CLARK

Suffix

Business Name

TED ROBERT CLARK MD

Original Issue Date

03/31/2009

Effective Date

06/28/2023

Expiration Date

07/31/2026

City

SPRINGFIELD

State

Zip

62781

County

SANGAMON

Ever Disciplined

LastModifiedDate

06/28/2023