STEPHEN GREGORY CLARK DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125065946

License Status

CANCELLED

Business

Title

First Name

STEPHEN

Middle

GREGORY

Last Name

CLARK

Business Name

STEPHEN GREGORY CLARK DO

Original Issue Date

07/01/2014

Effective Date

07/01/2014

Expiration Date

06/30/2017

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

06/26/2014