JUNIPER J LEE-PARK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****53

License Status

NOT RENEWED

Business

Title

First Name

JUNIPER

Middle

Last Name

LEE-PARK

Business Name

JUNIPER J LEE-PARK MD

Original Issue Date

02/07/2020

Effective Date

06/23/2020

Expiration Date

07/31/2023

City

CENTRALIA

State

Zip

62801

County

MARION

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/30/2023