RUSSELL JAY CLARK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036159690

License Status

NOT RENEWED

Business

Title

First Name

RUSSELL

Middle

JAY

Last Name

CLARK

Business Name

RUSSELL JAY CLARK MD

Original Issue Date

03/07/2022

Effective Date

03/07/2022

Expiration Date

07/31/2023

City

LA GRANGE

State

Zip

78945

Ever Disciplined

LastModifiedDate

11/30/2023