DEREK E CLEVIDENCE MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036100512

License Status

INACTIVE

Business

First Name

DEREK

Middle

Last Name

CLEVIDENCE

Suffix

Business Name

DEREK E CLEVIDENCE MD

Original Issue Date

07/02/1999

Effective Date

07/02/1999

Expiration Date

07/31/2002

City

COTTAGE GROVE

State

Zip

53527

County

WISCONSIN

Ever Disciplined

LastModifiedDate

10/09/2006