THOMAS PHILIP LAKE MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036043533

License Status

INACTIVE

Business

First Name

THOMAS PHILIP

Last Name

LAKE

Suffix

Business Name

THOMAS PHILIP LAKE MD

Original Issue Date

07/13/1970

Effective Date

07/13/1970

Expiration Date

07/31/2005

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Ever Disciplined

LastModifiedDate

10/09/2006