GAYLIN DUANE LACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036060129

License Status

NOT RENEWED

Business

First Name

GAYLIN

Middle

DUANE

Last Name

LACK

Suffix

Business Name

GAYLIN DUANE LACK MD

Original Issue Date

03/13/1980

Effective Date

04/15/2011

Expiration Date

07/31/2014

City

COEUR D ALENE

State

Zip

83814

County

IDAHO

Ever Disciplined

LastModifiedDate

11/17/2014