GRACE LEE PARK MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125049902

License Status

CANCELLED

Business

First Name

GRACE

Middle

LEE

Last Name

PARK

Suffix

Business Name

GRACE LEE PARK MD

Original Issue Date

07/01/2005

Effective Date

07/01/2005

Expiration Date

06/30/2008

City

URBANA

State

Zip

61801

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

09/22/2006