HEATHER MICHELLE 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

Title

First Name

HEATHER

Middle

MICHELLE

Last Name

CLARK

Business Name

HEATHER MICHELLE CLARK MD

Original Issue Date

08/19/2010

Effective Date

08/19/2010

Expiration Date

07/31/2011

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/10/2011