JON P LAKE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036079813

License Status

NOT RENEWED

Business

First Name

JON P

Last Name

LAKE

Suffix

Business Name

JON P LAKE MD

Original Issue Date

03/31/1990

Effective Date

03/31/1990

Expiration Date

07/31/1993

City

EFFINGHAM

State

Zip

62401

County

EFFINGHAM

Ever Disciplined

LastModifiedDate

09/20/2006