LOGAN LACKEY MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****33

License Status

ACTIVE

Business

Title

First Name

LOGAN

Last Name

LACKEY

Business Name

LOGAN LACKEY MD

Original Issue Date

06/17/2022

Effective Date

06/29/2023

Expiration Date

07/31/2026

City

QUINCY

State

Zip

62301

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/29/2023