FREDERIC CARROLL PARK MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****83

License Status

ACTIVE

Business

Title

First Name

FREDERIC

Middle

CARROLL

Last Name

PARK

Business Name

FREDERIC CARROLL PARK MD

Original Issue Date

07/20/2022

Effective Date

06/14/2023

Expiration Date

07/31/2026

City

CARBONDALE

State

Zip

62901

County

JACKSON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/14/2023