SUE ELLEN CLARK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****41

License Status

NOT RENEWED

Business

First Name

SUE ELLEN

Last Name

CLARK

Suffix

Business Name

SUE ELLEN CLARK MD

Original Issue Date

06/10/1996

Effective Date

10/01/2020

Expiration Date

07/31/2023

City

PEORIA

State

Zip

61637

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023