JACK DWIGHT BAKER - Physician Assistant License in Wisconsin | # 085000005

JACK DWIGHT BAKER

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000005

License Status

INACTIVE

Business

N

First Name

JACK DWIGHT

Last Name

BAKER

Business Name

JACK DWIGHT BAKER

Original Issue Date

11/05/1980

Effective Date

11/05/1980

Expiration Date

03/01/1994

State

WI

Ever Disciplined

N

LastModifiedDate

09/26/2006