BRIAN JOSEPH CLARK MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125058586

License Status

CANCELLED

Business

Title

First Name

BRIAN

Middle

JOSEPH

Last Name

CLARK

Business Name

BRIAN JOSEPH CLARK MD

Original Issue Date

06/23/2010

Effective Date

06/23/2010

Expiration Date

06/22/2013

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

04/06/2010