GREGORY J CLARK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****89

License Status

NOT RENEWED

Business

First Name

GREGORY J

Last Name

CLARK

Suffix

Business Name

GREGORY J CLARK MD

Original Issue Date

05/03/1991

Effective Date

05/03/1991

Expiration Date

07/31/1996

City

MOLINE

State

Zip

61265

County

ROCK ISLAND

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

09/26/2006