JODY HANNAH LACK MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****92

License Status

ACTIVE

Business

First Name

JODY

Middle

HANNAH

Last Name

LACK

Suffix

Business Name

JODY HANNAH LACK MD

Original Issue Date

03/12/2009

Effective Date

04/14/2023

Expiration Date

07/31/2026

City

SPRINGFIELD

State

Zip

62794

County

SANGAMON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/14/2023