CHANDLER WAYNE SPARKS DO Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125072862

License Status

CANCELLED

Business

Title

First Name

CHANDLER

Middle

WAYNE

Last Name

SPARKS

Business Name

CHANDLER WAYNE SPARKS DO

Original Issue Date

12/17/2021

Effective Date

12/17/2021

Expiration Date

06/30/2023

City

O FALLON

State

Zip

62269

County

SAINT CLAIR

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

12/17/2021