JACOB PAUL CLARK Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****37

License Status

ACTIVE

Business

First Name

JACOB

Middle

PAUL

Last Name

CLARK

Business Name

JACOB PAUL CLARK

Original Issue Date

08/12/2023

Effective Date

01/30/2026

Expiration Date

03/01/2028

City

PEORIA

State

Zip

61637

County

PEORIA

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

01/30/2026