HEATHER MICHELLE CLARK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036126519

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

FORT WAYNE

State

Zip

46825

Ever Disciplined

LastModifiedDate

11/14/2011