JAY SUNG PARK DO Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****95

License Status

NOT RENEWED

Business

Title

First Name

JAY

Middle

SUNG

Last Name

PARK

Business Name

JAY SUNG PARK DO

Original Issue Date

01/12/2017

Effective Date

01/12/2017

Expiration Date

07/31/2017

City

SPRINGFIELD

State

Zip

62769

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017