HEATHER MICHELLE CLARK MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125054028

License Status

CANCELLED

Business

Title

First Name

HEATHER

Middle

MICHELLE

Last Name

CLARK

Business Name

HEATHER MICHELLE CLARK MD

Original Issue Date

07/01/2008

Effective Date

07/01/2008

Expiration Date

06/30/2011

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

08/02/2010