TIMOTHY CLARK DYKSTRA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****01

License Status

NOT RENEWED

Business

First Name

TIMOTHY

Middle

CLARK

Last Name

DYKSTRA

Suffix

Business Name

TIMOTHY CLARK DYKSTRA MD

Original Issue Date

12/03/2002

Effective Date

07/21/2008

Expiration Date

07/31/2011

City

MACOMB

State

Zip

61455

County

MCDONOUGH

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

11/10/2011