TIMOTHY C LACKEY MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****53

License Status

ACTIVE

Business

First Name

TIMOTHY C

Last Name

LACKEY

Suffix

Business Name

TIMOTHY C LACKEY MD

Original Issue Date

08/11/1997

Effective Date

04/06/2023

Expiration Date

07/31/2026

City

MARYVILLE

State

Zip

62062

County

MADISON

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/06/2023