THEODORE E LANGE MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036098457

License Status

INACTIVE

Business

First Name

THEODORE

Middle

Last Name

LANGE

Suffix

Business Name

THEODORE E LANGE MD

Original Issue Date

07/27/1998

Effective Date

07/27/1998

Expiration Date

07/31/1999

City

EAGLE

State

Zip

83616

County

IDAHO

Ever Disciplined

LastModifiedDate

09/20/2006