MATTHEW ALAN THEOPHILUS CLARKE MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036110992

License Status

INACTIVE

Business

First Name

MATTHEW ALAN

Middle

THEOPHILUS

Last Name

CLARKE

Suffix

Business Name

MATTHEW ALAN THEOPHILUS CLARKE MD

Original Issue Date

03/11/2004

Effective Date

03/11/2004

Expiration Date

07/31/2005

City

LAURELTON

State

Zip

11422

County

NEW YORK

Ever Disciplined

LastModifiedDate

10/09/2006