MARK W DECLUTE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****09

License Status

NOT RENEWED

Business

First Name

MARK W

Last Name

DECLUTE

Suffix

Business Name

MARK W DECLUTE MD

Original Issue Date

07/21/1989

Effective Date

07/21/1989

Expiration Date

07/31/1996

City

PEORIA

State

Zip

61614

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/09/2006