HOLLACE D JACKSON - Medical Doctor License in New York | # 036105573

HOLLACE D JACKSON

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036105573

License Status

NOT RENEWED

Business

N

First Name

HOLLACE

Middle

D

Last Name

JACKSON

Business Name

HOLLACE D JACKSON

Original Issue Date

09/12/2001

Effective Date

09/12/2001

Expiration Date

07/31/2005

State

NY

Ever Disciplined

N

LastModifiedDate

10/09/2006