JACK DWIGHT BAKER Physician Assistant License verification

Business Entity

INACTIVE

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085000005

License Status

INACTIVE

Business

First Name

JACK DWIGHT

Last Name

BAKER

Business Name

JACK DWIGHT BAKER

Original Issue Date

11/05/1980

Effective Date

11/05/1980

Expiration Date

03/01/1994

City

BURLINGTON

State

Zip

53105

County

WISCONSIN

Ever Disciplined

LastModifiedDate

09/26/2006