TED ROBERT CLARK MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****94

License Status

ACTIVE

Business

First Name

TED

Middle

ROBERT

Last Name

CLARK

Suffix

Business Name

TED ROBERT CLARK MD

Original Issue Date

04/02/2009

Effective Date

06/28/2023

Expiration Date

07/31/2026

City

SPRINGFIELD

State

Zip

62781

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/28/2023