FREDERIC CARROLL PARK MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036160789

License Status

ACTIVE

Business

Title

First Name

FREDERIC

Middle

CARROLL

Last Name

PARK

Business Name

FREDERIC CARROLL PARK MD

Original Issue Date

06/07/2022

Effective Date

07/04/2023

Expiration Date

07/31/2026

City

CARBONDALE

State

Zip

62901

County

JACKSON

Ever Disciplined

LastModifiedDate

07/04/2023