BRIAN JOSEPH CLARK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****79

License Status

NOT RENEWED

Business

Title

First Name

BRIAN

Middle

JOSEPH

Last Name

CLARK

Business Name

BRIAN JOSEPH CLARK MD

Original Issue Date

06/26/2013

Effective Date

06/26/2013

Expiration Date

07/31/2014

City

CHICAGO

State

Zip

60622

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014