MARK RICHARD BAKER MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125068269

License Status

CANCELLED

Business

Title

First Name

MARK

Middle

RICHARD

Last Name

BAKER

Business Name

MARK RICHARD BAKER MD

Original Issue Date

06/26/2016

Effective Date

06/26/2016

Expiration Date

06/25/2019

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Emergency Medicine

Ever Disciplined

LastModifiedDate

05/10/2016