GAYLIN DUANE LACK MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****08

License Status

NOT RENEWED

Business

First Name

GAYLIN

Middle

DUANE

Last Name

LACK

Suffix

Business Name

GAYLIN DUANE LACK MD

Original Issue Date

01/01/1997

Effective Date

04/15/2011

Expiration Date

07/31/2014

City

PERU

State

Zip

61354

County

LA SALLE

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/17/2014