LACO LANE MACE II MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036122070

License Status

NOT RENEWED

Business

First Name

LACO

Middle

LANE

Last Name

MACE

Suffix

II MD

Business Name

LACO LANE MACE II MD

Original Issue Date

10/14/2008

Effective Date

05/13/2014

Expiration Date

07/31/2017

City

BRIDGEPORT

State

Zip

26330

County

WEST VIRGINIA

Ever Disciplined

LastModifiedDate

11/01/2017