SAMUEL S W PARK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****51

License Status

NOT RENEWED

Business

First Name

SAMUEL S W

Last Name

PARK

Suffix

Business Name

SAMUEL S W PARK MD

Original Issue Date

06/23/1983

Effective Date

05/03/2011

Expiration Date

07/31/2014

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

04/05/2020