CHERYL ANN CLARK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****21

License Status

NOT RENEWED

Business

Title

First Name

CHERYL

Middle

ANN

Last Name

CLARK

Business Name

CHERYL ANN CLARK MD

Original Issue Date

07/20/1998

Effective Date

09/22/2016

Expiration Date

07/31/2017

City

ROCKFORD

State

Zip

61103

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017