EDWARD PARK DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036128836

License Status

NOT RENEWED

Business

Title

First Name

EDWARD

Last Name

PARK

Business Name

EDWARD PARK DO

Original Issue Date

08/23/2011

Effective Date

04/15/2014

Expiration Date

07/31/2017

City

NORMAL

State

Zip

61761

County

MCLEAN

Ever Disciplined

LastModifiedDate

11/01/2017