JERRY G BACK MD Medical Doctor License verification

Business Entity

INACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036077259

License Status

INACTIVE

Business

First Name

JERRY G

Last Name

BACK

Suffix

Business Name

JERRY G BACK MD

Original Issue Date

06/30/1988

Effective Date

06/30/1988

Expiration Date

07/31/1990

City

LAPORTE

State

Zip

48350

County

INDIANA

Ever Disciplined

LastModifiedDate

09/20/2006