AGATHA LEE PARK MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036042638

License Status

INACTIVE

Business

First Name

AGATHA LEE

Last Name

PARK

Suffix

Business Name

AGATHA LEE PARK MD

Original Issue Date

07/07/1969

Effective Date

07/07/1969

Expiration Date

07/31/1987

City

ST LOUIS

State

Zip

63136

County

MISSOURI

Ever Disciplined

LastModifiedDate

09/20/2006