HOLLIS J CLARK Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****89

License Status

NOT RENEWED

Business

First Name

HOLLIS

Middle

Last Name

CLARK

Business Name

HOLLIS J CLARK

Original Issue Date

06/26/2015

Effective Date

03/01/2022

Expiration Date

03/01/2024

City

METROPOLIS

State

Zip

62960

County

MASSAC

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/05/2025