License Verification

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JACK DOUGLAS SCOTT MD

License Number: ME69637

Data As Of 11/22/2024

Profession
Medical Doctor
License
ME69637
License Status
CLEAR/Active
License Expiration Date
1/31/2025
License Original Issue Date
12/04/1995
Address of Record
Lutheran Hospital
FORT WAYNE, IN 46804
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No

No secondary locations found.


Name Relationship Profession License Effective Date

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Name Relationship Profession License Effective Date
CERANOWSKI, MICHAEL JAMES Prescribing Physician Assistant Physician Assistant 9104159 6/28/2017
FOWLER JR, TIMOTHY DALE Prescribing Physician Assistant Physician Assistant 9110560 9/6/2017
GLOBERMAN, MARK ALLEN Prescribing Physician Assistant Physician Assistant 9108397 7/26/2017
LYSACK, GLENN JOSEPH Prescribing Physician Assistant Physician Assistant 3242 9/13/2019

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Name Relationship Profession License Effective Date

Click on the License Number to view License Details for that Practitioner



No Continuing Education Hours Received from Approved Providers As Of 11/22/2024



* To find out more about Approved Providers, or ask a provider why the course you took is not yet listed, please visit our Continuing Education Providers page.


** Personal Development is limited to no more than 3 hours per renewal cycle. Any personal development hours in excess of this 3 hour maximum cannot be used for renewal and have been subtracted from the total available for renewal.


Please do not fax proof of Continuing Education hours to the Board Office until you have received your renewal notice in the mail.


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