DEREK LANE FLACK DO Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125069426

License Status

EXPIRED

Business

Title

First Name

DEREK

Middle

LANE

Last Name

FLACK

Business Name

DEREK LANE FLACK DO

Original Issue Date

07/01/2016

Effective Date

07/01/2016

Expiration Date

06/30/2019

City

PEORIA

State

Zip

61605

County

PEORIA

Specialty/Qualifier

Family Medicine

Ever Disciplined

LastModifiedDate

10/02/2019