JEFFREY C G MARK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****27

License Status

NOT RENEWED

Business

First Name

JEFFREY C G

Last Name

MARK

Suffix

Business Name

JEFFREY C G MARK MD

Original Issue Date

08/29/1996

Effective Date

08/29/1996

Expiration Date

07/31/1999

City

NORTH CHICAGO

State

Zip

60064

County

LAKE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006