JODY HANNAH LACK MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125051947

License Status

CANCELLED

Business

First Name

JODY

Middle

HANNAH

Last Name

LACK

Suffix

Business Name

JODY HANNAH LACK MD

Original Issue Date

06/25/2006

Effective Date

06/25/2006

Expiration Date

06/24/2009

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

Pediatrics

Ever Disciplined

LastModifiedDate

09/22/2006