REBECCA LONG LARK Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****47

License Status

NOT RENEWED

Business

First Name

REBECCA

Last Name

LONG LARK

Business Name

REBECCA LONG LARK

Original Issue Date

04/11/1997

Effective Date

04/11/1997

Expiration Date

07/31/1999

City

CHICAGO

State

Zip

60637

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006