CLARKE WILSON MANGUN JR MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036041342

License Status

INACTIVE

Business

First Name

CLARKE

Middle

WILSON

Last Name

MANGUN

Suffix

JR MD

Business Name

CLARKE WILSON MANGUN JR MD

Original Issue Date

08/07/1967

Effective Date

04/17/2008

Expiration Date

07/31/2011

City

LENEXA

State

Zip

66215

County

KANSAS

Ever Disciplined

LastModifiedDate

04/07/2011