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Oklahoma Board of Medical Licensure and Supervision

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LACKEY, LAWRENCE SEVALLIA       
This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
Practice Address: 310 VISGER RD
RIVER ROUGE MI 48218-1097

Address last updated on 12/23/1999
Phone #:
Fax #:
County: NOT OKLAHOMA
License: 10946
Dated: 7/27/1976
Expires: 6/30/1992
License Type: Medical Doctor
Specialty: Internal Medicine
Status: Inactive
Status Class: Deceased
Restricted to:
Registered to Dispense: NO
Medical School: Univ Of KS Sch Of Med, Kansas City Ks 66103
Graduated: / 1952
CME Year:
Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Certifications:
New Patients: No
Medicaid: No
Medicare: No
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
310 VISGER RD
RIVER ROUGE MI 48218-1097

Phone #:
Fax #:

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