DANE JACK CHURCH MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036148467

License Status

ACTIVE

Business

Title

First Name

DANE

Middle

JACK

Last Name

CHURCH

Business Name

DANE JACK CHURCH MD

Original Issue Date

03/06/2019

Effective Date

05/02/2023

Expiration Date

07/31/2026

City

SPRINGFIELD

State

Zip

62711

County

SANGAMON

Ever Disciplined

LastModifiedDate

05/02/2023