DERIC M PARK MD Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125034311

License Status

EXPIRED

Business

Title

First Name

DERIC

Middle

Last Name

PARK

Business Name

DERIC M PARK MD

Original Issue Date

05/09/1996

Effective Date

05/09/1996

Expiration Date

06/16/2000

City

CHICAGO

State

Zip

60637

County

COOK

Specialty/Qualifier

Neurology

Ever Disciplined

LastModifiedDate

09/22/2006