JACQUELYN L CLARK Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125021276

License Status

EXPIRED

Business

First Name

JACQUELYN

Middle

Last Name

CLARK

Business Name

JACQUELYN L CLARK

Original Issue Date

06/11/1987

Effective Date

06/11/1987

Expiration Date

07/01/1990

City

PARK RIDGE

State

Zip

60068

County

COOK

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006