SEA MI PARK MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****57

License Status

ACTIVE

Business

Title

First Name

SEA

Middle

Last Name

PARK

Business Name

SEA MI PARK MD

Original Issue Date

08/01/2023

Effective Date

08/01/2023

Expiration Date

07/31/2026

City

LAFAYETTE

State

Zip

70503

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

08/01/2023